Still yellow at three weeks

A breastfed 3-week-old is thriving but has never lost her jaundice. The health visitor sends her in 'just to check'.

Age22 daysWeight3.9 kgVitals read against the newborn band

Pediatrics

22 days old· newborn3.9 kggirl, Pediatric assessment unitFictitious educational patient

Caregiver: Mother: 'She has been a little yellow since day three. Everyone said it was breastfeeding jaundice and it would go. She feeds well and has gained weight. Her poo has gone quite pale, like putty, and her wee looks dark on the nappy.'
Feeding: Breastfed 8 to 10 times a day, gaining 30 g a day.
Intake and output: Six or more wet diapers; stools pale for about a week.
Birth: Term, 3.3 kg, no antenatal concerns. Blood group O positive, mother O positive.

Term, breastfed

Day 22 · 10:00

A well, yellow baby

She is alert, feeding, plump. Her skin and sclerae are yellow. The liver edge is palpable 2.5 cm below the costal margin, firm. In the nappy, the stool is pale beige.

Vitals

HR 138RR 40SpO2 99Newborn band · HR 100 to 205 · RR 30 to 53

HR138BP76/44RR40SpO299%T36.9

Read against the newborn band (birth to 28 days): HR 100 to 205 awake, RR 30 to 53, hypotension below 60 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Everyone has said breastfeeding jaundice. What in this story says otherwise?

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