Physical Exam Key Points

1. General appearance and vital signs. May suggest infection. Patients with kernicterus may have retrocollis and opisthotonus (backward neck and back arching).

2. Skin. Assess color for pallor or jaundice. Although neonatal jaundice follows a cephalocaudal progression, do not rely on visual diagnosis alone. Visual determination of jaundice is unreliable and imprecise and has been associated with more than several cases of kernicterus.

3. Abdomen. Assess for hepatosplenomegaly, which may be seen in several infectious and metabolic processes. Splenomegaly should raise suspicion of hemolytic anemia.

B. Laboratory Data. Testing should be guided by clinical suspicion. Any occurrence of jaundice in the first 24 hours of life should be followed up with a serum bilirubin level.

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