# Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy term infants and their mothers during the first weeks after discharge from a lying-in clinic. The nurse reviews the jaundice findings of four term newborns seen on home visits. All four are active. Which newborn's jaundice fits physiologic jaundice?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629428  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy term infants and their mothers during the first weeks after discharge from a lying-in clinic.

The nurse reviews the jaundice findings of four term newborns seen on home visits. All four are active. Which newborn's jaundice fits physiologic jaundice?

## 보기

1. A 4-day-old whose yellow color began at 48 hours, with yellow stools **✔ 정답**
2. A 10-day-old whose yellow color began on day 8, gaining weight well
3. A 5-day-old whose yellow color began on day 3, with pale, chalky stools
4. A 30-hour-old whose yellow color was first seen at 18 hours of age

**정답: 1**

## 해설

Three features must fit at once. Physiologic jaundice appears after 24 hours, peaks at about days 3 to 5 in term infants, and is unconjugated in a well infant with normal yellow stools. Onset before 24 hours is pathologic, onset after the first week in a thriving breastfed infant is breast milk jaundice, and pale stools point to conjugated hyperbilirubinemia, which is never physiologic.

## 심화 해설

Three features must fit at once
Physiologic jaundice is defined by a pattern, not by any single finding. In a term infant it appears after 24 hours of age, peaks at about days 3 to 5, and is due to unconjugated bilirubin in a well infant who passes normal yellow stools. The 4-day-old whose color began at 48 hours, who is active and has yellow stools, meets all three conditions. Timing of onset, the infant's well-being, and the stool color must all point the same way before jaundice is called physiologic.

Why physiologic jaundice happens
Newborns have a high red cell mass, red cells with a shorter life span, and an immature liver enzyme system for conjugating bilirubin. They also reabsorb more bilirubin from the gut. The result is a temporary rise in unconjugated bilirubin that becomes visible after the first day and fades within the first one to two weeks. Because conjugation and excretion into bile are working, stools remain yellow.

Comparing the four newborns

| Newborn | Key finding | Interpretation |
| --- | --- | --- |
| 4-day-old, onset at 48 hours, yellow stools | Onset after 24 hours, normal stools, active | Physiologic jaundice |
| 10-day-old, onset on day 8, gaining well | Onset after the first week in a thriving infant | Breast milk jaundice |
| 5-day-old, onset on day 3, pale chalky stools | Pale stools | Conjugated hyperbilirubinemia; never physiologic |
| 30-hour-old, first seen at 18 hours | Onset before 24 hours | Pathologic until proven otherwise |

Traps in the distractors
Watch out! The 5-day-old has an onset on day 3 that fits the physiologic timeline, but pale, chalky stools mean bilirubin is not reaching the gut, as in biliary atresia. This is conjugated hyperbilirubinemia and needs urgent evaluation. The 30-hour-old is now older than 24 hours, but what counts is when the jaundice was first seen; onset at 18 hours is pathologic even though the baby is older now. The 10-day-old fits breast milk jaundice, which begins after the first week in a well, gaining breastfed infant.

Exam takeaway
Jaundice before 24 hours is pathologic, and pale stools are never physiologic. On home visits, the nurse asks when the yellow color began, checks feeding and activity, and looks at stool and urine color. Any newborn whose jaundice does not fit the physiologic pattern is referred for bilirubin testing.

## 임상 시나리오

Recognizing Physiologic JaundiceHome visit to term newborns
Physiologic jaundice in a term infant appears after 24 hours, peaks around days 3 to 5, and occurs in a well infant with yellow stools.

Onset after the first week in a thriving breastfed infant suggests breast milk jaundice.

Record when the color first appeared, the infant's activity and feeding, and stool and urine color at every visit.

CautionJaundice first seen before 24 hours, or any jaundice with pale, chalky stools, needs prompt referral. Pale stools are never physiologic.

## 핵심 개념

- **Physiologic jaundice** — Mild unconjugated hyperbilirubinemia in a well newborn appearing after 24 hours and resolving within the first weeks.
- **Unconjugated bilirubin** — Fat-soluble bilirubin not yet processed by the liver; it causes physiologic jaundice in newborns.
- **Conjugated hyperbilirubinemia** — Raised water-soluble bilirubin from impaired bile flow, often with pale stools and dark urine.
- **Breast milk jaundice** — Jaundice that begins after the first week in a well, gaining breastfed infant.
- **Biliary atresia** — Obstruction of the bile ducts in infancy causing conjugated jaundice and pale stools.

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