The nurse is reviewing the medical records of several newborns. Which infant requires immediate intervention?
1. 24-hour-old term male with total bilirubin level of 2
2. 3-day-old term bottle-fed female with bilirubin of 11
3. 2-week-old postterm breastfed male with bilirubin of 10
4. 12-hour-old preterm female exhibiting icterus and lethargy
4
Explanation:
1. Total bilirubin levels under 3 are expected in the first 24 hours of life.
2. Physiologic jaundice peaks between days 3 and 5; a total bilirubin level of 11 is not treated with phototherapy, regardless of feeding method.
3. Breast milk jaundice peaks at 2 to 3 weeks of age and commonly presents with a total bilirubin level of 5 to 10.
4. Jaundice is an indication of hyperbilirubinemia and is not an expected finding in the first day of life. Lethargy can be a sign of kernicterus developing. Preterm infants are more likely to develop jaundice.
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