In the ED, you see a well appearing African-American baby boy with normal vital signs and a normal head-to-toe newborn exam; he has yellow palms. There is no family history of metabolic syndrome or blood dyscrasia.
You decide to check his total bilirubin level, which results at 11 mg/dL. The parents are concerned, especially the father, who recently had routine blood tests with a total bilirubin of 0.8 mg/dL –“my son has a level 10 times higher than me – and he’s so little!”. Regarding the management of your patient, which of the following is the single BEST answer:
A. Observe the child in the ED and recheck his total bilirubin in 2-4 hours
B. Give IV fluids and consider phototherapy
C. Ask the mother what time of the day the child was born
D. Admit the child for further workup
In the meantime, a quote: "An observant parent's evidence may be disproved but should never be ignored." --Anonymous Lancet 1:688, 1951