Case history
Case history #1
A neonate 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 breast-feed the neonate. At 24 hours of life, the neonate is noted to be jaundiced and the total serum bilirubin is noted to be 7 mg/dL. He is discharged home later the same day with an appointment for follow-up with the pediatrician at 1 week of age. However, 48 hours later, the neonate is brought to the emergency room. History from the mother reveals that the neonate has progressively become more jaundiced, is not breast-feeding well and is lethargic. Examination also reveals evidence of moderate volume depletion and significant jaundice (including the soles). The neurologic exam is normal and total serum bilirubin is 20 mg/dL.
Case history #2
A term neonate is born to a mother who had a previous baby with a history of jaundice in the newborn period, not requiring hospitalization. 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 neonate is noted to be jaundiced and the total serum bilirubin is 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 backward arching of the neck (retrocollis) and trunk (opisthotonus). Decreased tone and abnormal Moro reflex are possible manifestations.
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