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Neonatal hyperbilirubinemia — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Neonatal hyperbilirubinemiaUSMLE Step 3

A 4-day-old term infant is lethargic with a high-pitched cry, retrocollis, and poor feeding. Total bilirubin is above the age-specific exchange-transfusion threshold despite intensive phototherapy. What is the best next step?

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Correct answer: B — Arrange urgent exchange transfusion while continuing intensive phototherapy

The best answer is “Arrange urgent exchange transfusion while continuing intensive phototherapy”. The neurologic findings indicate acute bilirubin encephalopathy and the bilirubin exceeds the exchange threshold. Intensive phototherapy continues while urgent exchange transfusion is arranged. Acute bilirubin encephalopathy or exchange-threshold bilirubin requires escalation and urgent exchange transfusion preparation.

Reference: AAP 2022 Hyperbilirubinemia Guideline: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of