History of Present Illness Onset and progression of jaundiced skin Feeding: breast milk or formula? Current weight compared to birth weight. Gaining weight appropriately? Number of wet diapers per day? (Indicator of hydration status) Consistency and colour of stool?(pale stool implies poor bili excretion) Infections or fever? Medications? (newborn or mother) General activity: irritable? lethargic? Gender & ethnicity? (Males, Asians, and Blacks have some increased riskPerinatal History Maternal blood group Maternal illnesses or infections Results of antenatal screening tests Maternal medicine or drug intake Delayed cord clamping (could indicate polycythemia) Birth trauma with bruising Results of newborn screening testsFamily History: Previous siblings with neonatal jaundice Other family members with jaundice Anemia or blood disorders Splenectomy Bile stones or gallbladder removalMerck ManualHistory of present illness should note age of onset and duration of jaundice. Important associated symptoms include lethargy and poor feeding (suggesting possible kernicterus), which may progress to stupor, hypotonia, or seizures and eventually to hypertonia. Patterns of feeding can be suggestive of possible breastfeeding failure or underfeeding. Therefore, history should include what the infant is being fed, how much and how frequently, urine and stool production (possible breastfeeding failure or underfeeding), how well the infant is latching on to the breast or taking the nipple of the bottle, whether the mother feels that her milk has come in, and whether the infant is swallowing during feedings and seems satiated after feedings.Review of systems should seek symptoms of causes, including respiratory distress, fever, and irritability or lethargy (sepsis); hypotonia and poor feeding (hypothyroidism, metabolic disorder); and repeated episodes of vomiting (intestinal obstruction).Past medical history should focus on maternal infections (toxoplasmosis, other pathogens, rubella, cytomegalovirus, and herpes simplex [TORCH] infections), disorders that can cause early hyperbilirubinemia (maternal diabetes), maternal Rh factor and blood group (maternofetal blood group incompatibility), and a history of a prolonged or difficult birth (hematoma or forceps trauma).Family history should note known inherited disorders that can cause jaundice, including G6PD deficiency, thalassemias, and spherocytosis, and also any history of siblings who have had jaundice.Drug history should specifically note drugs that may promote jaundice (eg, ceftriaxone, sulfonamides, antimalarials).MedscapePresentation and duration of neonatal jaundice Typically, presentation is on the second or third day of life. Jaundice that is visible during the first 24 hours of life is likely to be nonphysiologic; further evaluation is suggested. Infants who present with jaundice after 3-4 days of life may also require closer scrutiny and monitoring. In infants with severe jaundice or jaundice that continues beyond the first 1-2 weeks of life, the results of the newborn metabolic screen should be checked for galactosemia and congenital hypothyroidism, further family history should be explored (see below), the infant's weight curve should be evaluated, the mother's impressions as far as adequacy of breastfeeding should be elicited, and the stool color should be assessed.Family history Previous sibling with jaundice in the neonatal period, particularly if the jaundice required treatment Other family members with jaundice or known family history of Gilbert syndrome Anemia, splenectomy, or bile stones in family members or known heredity for hemolytic disorders Liver disease in family membersHistory of pregnancy and delivery Maternal illness suggestive of viral or other infection Maternal drug intake Delayed cord clamping Birth trauma with bruising and/or fractures.Postnatal history Loss of stool color Breastfeeding Greater than average weight loss Symptoms or signs of hypothyroidism Symptoms or signs of metabolic disease (eg, galactosemia) Exposure to total parental nutrition