The home care nurse is examining a 3-day-old infant. The child's skin on the sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. The best response from the nurse is:

Question

1. "The liver of an infant is not fully mature, and doesn't conjugate the bilirubin for excretion."
2. "The infant received too many red blood cells after delivery because the cord was not clamped immediately."
3. "The yellow color of your baby's skin indicates that you are breastfeeding too often."
4. "This is an abnormal finding related to your baby's bowels' not excreting bilirubin as they should."

Answer 1

1
Rationale 1: Physiologic jaundice is a common occurrence, and peaks on day 3 or 4. It happens in part because of the RBC destruction that infants experience combined with liver immaturity, which leads to less efficient conjugation of bilirubin for excretion.
Rationale 2: The conjugation of bilirubin has nothing to do with cord clamping.
Rationale 3: Bilirubin binds to the proteins in breast milk and formula for excretion through the bowels. Frequent feeding, therefore, will decrease jaundice.
Rationale 4: Bilirubin binds to the proteins in breast milk and formula for excretion through the bowels.