Case history
Case history #1
A baby boy of approximately 36 weeks gestational age is born to a primigravida mother. Pregnancy and delivery are uncomplicated, with Apgar scores of 9 at 1 and 5 minutes. Mother's and baby's blood groups are both O+. Mother chooses to exclusively breastfeed the baby. At 24 hours of life, the baby is noted to be jaundiced and the total serum bilirubin is noted to be 119.7 micromol/L (7 mg/dL). He is discharged home later the same day with an appointment for follow-up with the paediatrician at 1 week of age. However, 48 hours later, the baby is brought to the emergency department. History from the mother reveals that the baby has progressively become more jaundiced, is not breastfeeding well and is lethargic. Examination also reveals evidence of moderate volume depletion and significant jaundice (including the soles). The neurological examination is normal and total serum bilirubin is 342.1 micromol/L (20 mg/dL).
Case history #2
A term baby is born to a mother who had a previous baby with a history of jaundice in the newborn period, not requiring hospitalisation. Pregnancy and delivery are uncomplicated, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Mother's and baby's blood groups are O+ and B+, respectively. At 12 hours of life, the baby is noted to be jaundiced and the total serum bilirubin is 85.5 micromol/L (5 mg/dL). Tests reveal direct Coombs' test to be positive and presence of microspherocytes on the peripheral smear.
Other presentations
The neonate may present with clinical signs of bilirubin encephalopathy. These include irritability with a high-pitched cry, possibly fever and increased muscle tone (usually involving the extensor group of muscles), and characteristically intermittent backwards arching of the neck (retrocollis) and trunk (opisthotonus). Decreased tone and abnormal Moro reflex are possible manifestations.
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