A 48-Hour-Old Boy Is Evaluated in the Newborn Nursery on Morning

question 915

Multiple Choice

A 48-hour-old boy is evaluated in the newborn nursery on morning rounds.  The infant has been breastfeeding exclusively with good latch.  He passed meconium yesterday and has urinated several times, but the parents are concerned about his increasing yellow discoloration.  He was born at 38 weeks gestation via normal spontaneous vaginal delivery.  Review of prenatal records shows a maternal blood type of O+ and normal routine blood testing.  Physical examination shows an alert, nondysmorphic boy with a strong suck and intact Moro reflex.  He has icteric sclerae and appears jaundiced from head to feet.  The abdomen is soft, nontender, and nondistended.  The liver is palpable 1 cm below the right costal margin.  The examination is otherwise unremarkable.  The infant's blood is drawn at 49 hours of life; laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient?

• A)Complete blood count, blood culture, and empiric antibiotic therapy
• B)Discontinue breastfeeding and start total parenteral nutrition
• C)Gradual removal of the patient's blood and replacement with donor blood
• D)Hepatitis B serologies and immunoglobulin therapy
• E)Placement near a window for exposure to direct sunlight

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Definitions:

Productive Number of Sales Calls

The quantity of sales calls that effectively lead to a desired outcome, such as generating a lead or closing a sale.

Relationship Network

A web of personal and professional contacts that can provide support, information, and opportunities for individuals or businesses.

Sales Technology

The transformation of manual sales activities to electronic processes through the use of various combinations of hardware and software applications.

Emotional Intelligence

The ability to recognize, understand, manage, and reason with emotions in oneself and others, facilitating interpersonal communication and decision-making.