Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-08-10 Encounter: Spruce text message with photo and video review CC: Newborn jaundice with concern for worsening hyperbilirubinemia, excessive sleepiness, and difficulty feeding. HPI: Baby Gus was born on or around 8/5/2026 via c-section and noted to be mildly jaundiced on 8/10/2026. A direct bilirubin (dbili) lab had been obtained but the sample was hemolyzed and flagged as potentially artificially low. Parents noted a history of elevated bilirubin in their older child Walt that required close monitoring. By 8/12/2026, Gus was noted to be increasingly sleepy, difficult to rouse for feeds, nursing for only 2–4 minutes before falling asleep, and requiring wake-ups every 2.5–3 hours overnight. Parents also reported an unusual breathing pattern on 8/13/2026 with rapid shallow breaths (RR 52–66/min) and apparent abdominal retractions, captured on video. By 8/15/2026, sleepiness persisted and weight was uncertain — birth weight was 8 lb 14 oz, a discharge weight of approximately 8 lb 2.6 oz was recorded by the delivering provider, and a home scale suggested approximately 10 lbs. Assessment: Dr. Hobbs assessed jaundice as mild based on photo review, noting color had not worsened and adequate diaper output was reassuring. Excessive sleepiness with brief feeds was monitored closely. The breathing pattern observed on video was identified as periodic breathing — a normal newborn variant — along with normal abdominal breathing mechanics. Weight discrepancy between home scale and prior clinical measurement was flagged as needing formal resolution at the upcoming in-person visit. Plan: Parents instructed to monitor color (worsening orange hue), feeding duration, and level of alertness, and to connect with Dr. Hobbs if feeding seemed diminished or sleepiness worsened. Daily check-ins requested. Breathing pattern reassured as normal (periodic breathing). Formal weight check planned at the in-office 2-week newborn visit scheduled for 8/19/2026. No medications prescribed. Key clinical quotes: "great pics! only looking mildly yellow to me. jaundice is like a thermometer, gets worse on the face and then when it worsens, goes down the body" "If feeding seems diminished, he seems more sleepy, let's connect" "no, that's actually good, it's called periodic breathing, a normal newborn behavior as well as the belly breathing" Source: Spruce conversation t_2MJ659J6T4000