Jaundice in a 3-Day-Old Term Breastfed Baby: Assessment and Management
A branching clinical case simulation for a patient presenting with visible jaundice to the abdomen, transcutaneous bilirubin above phototherapy threshold. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 4medium20 min6 stages
- Patient
- 3 years, female
- Presenting complaint
- Visible jaundice to the abdomen, transcutaneous bilirubin above phototherapy threshold.
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are a fourth-year medical student in the emergency department of a district general hospital. A 3-day-old term baby, Emily, is brought in by her mother because a community midwife noted yellow discolouration of the skin. Emily is exclusively breastfed, born at 39 weeks by spontaneous vaginal delivery. The mother reports the baby has been feeding reasonably well but has had fewer wet nappies over the last 24 hours. On triage, the baby is pink, alert, and active, with a temperature of 36.8°C. A transcutaneous bilirubin (TcB) reading is obtained: 320 µmol/L. The phototherapy threshold for this baby's age and risk factors is approximately 250 µmol/L. Your task is to assess, investigate, and manage this condition.
What this case teaches
Assess jaundice by age and risk factors; use the treatment threshold chart; start phototherapy; exclude haemolysis and sepsis; support feeding and follow up.
How the case unfolds
- 1History: what do you need to ask?History
- 2Examination: what will you assess?Examination
- 3Investigations: what tests will you order?Investigations
- 4Diagnosis: what is your working diagnosis?Diagnosis
- 5Treatment: how will you manage this baby?Treatment
- 6Monitoring and follow-upMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.