A 5 Day Old Baby Brought By A Concerned Mother Because The Child Has Yellow Skin And Eyes

Mother of a 5 day old baby boy comes to the doctor's office because she has noticed her baby having yellow discoloration of the eyes and skin for 2 days. The condition has not worsened and the baby is awake, responsive, playful and active. He is breast fed and has 2 -3 bowel movements daily. The color of the stool is brown. He is wetting 7-8 diapers per day every 3-4 hours. Mother denies the baby having any history of fever, vomiting, seizure or breathlessness. Mother had a healthy pregnancy and the baby was delivered vaginally at full term.
The picture of the neonate is shown below:

On the basis of the history given above and the appearance of the baby in the photo what could be the differential diagnosis?
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Differential Diagnosis:

• Physiologic jaundice
• Breast feeding jaundice
• ABO or Rh incompatibility.
• Neonatal sepsis
• Polycythemia
• Familial neonatal hyperbilirubinemia

What Diagnostic Workup Will You Advice?

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Diagnostic Workup:

• Total and indirect billirubin
• Blood typing. 
• Direct Coomb's test
• C reactive protein
• Complete blood count

Physiologic Jaundice is a condition that peaks between the third and seveth day of life. Underlying cause is the accelerated destruction of erythrocytes, decreased excretory capacity and decreased activity of the billirubin conjugating enzymes in hepatic cells. It is more commoly seen in preterms babies but can also been seen in normal term neonates.