1. E
2. E.
3. B
ABO incompatibility is the most likely diagnosis. Mother is group O, baby group A: this is the most common ABO incompatibility. Maternal blood will contain group A antibodies, which cross into the baby and haemolyse red blood cells. Prolonged rupture of membranes may increase the likelihood of neonatal sepsis: however, lack of signs on examination, normal white count, differential and platelet count mitigate against this diagnosis.
Breast milk jaundice is a diagnosis of exclusion only when a well baby is in the phase of prolonged unconjugated jaundice.
Most bilirubin will be unconjugated at this stage. Serum haptoglobin level is not indicated. In a well baby at 32 h of age, urea and electrolyte values are likely to reflect maternal electrolyte levels just before birth and there is no history suggesting that these might have become deranged. Glucose-6-phosphate dehydrogenase deficiency is X-linked co-dominant and less likely to manifest in female babies. Osmotic fragility test is an outmoded test for hereditary spherocytosis.
Double phototherapy and antibiotic cover are appropriate in this case although infection is less likely than ABO incompatibility. The bilirubin rise was steep and contingency plans might be made for an exchange transfusion, but in this baby’s case, ‘double phototherapy’ interrupted the rise in bilirubin and no exchange transfusion was needed.
Adequate hydration must be maintained during phototherapy. While some neonatologists would give oral dextrose, or formula supplementation (after discussion with parents), others might give some intravenous supplementation until breast milk comes in. The fluid prescription proposed here is inappropriate in volume and composition.
2. E.
3. B
ABO incompatibility is the most likely diagnosis. Mother is group O, baby group A: this is the most common ABO incompatibility. Maternal blood will contain group A antibodies, which cross into the baby and haemolyse red blood cells. Prolonged rupture of membranes may increase the likelihood of neonatal sepsis: however, lack of signs on examination, normal white count, differential and platelet count mitigate against this diagnosis.
Breast milk jaundice is a diagnosis of exclusion only when a well baby is in the phase of prolonged unconjugated jaundice.
Most bilirubin will be unconjugated at this stage. Serum haptoglobin level is not indicated. In a well baby at 32 h of age, urea and electrolyte values are likely to reflect maternal electrolyte levels just before birth and there is no history suggesting that these might have become deranged. Glucose-6-phosphate dehydrogenase deficiency is X-linked co-dominant and less likely to manifest in female babies. Osmotic fragility test is an outmoded test for hereditary spherocytosis.
Double phototherapy and antibiotic cover are appropriate in this case although infection is less likely than ABO incompatibility. The bilirubin rise was steep and contingency plans might be made for an exchange transfusion, but in this baby’s case, ‘double phototherapy’ interrupted the rise in bilirubin and no exchange transfusion was needed.
Adequate hydration must be maintained during phototherapy. While some neonatologists would give oral dextrose, or formula supplementation (after discussion with parents), others might give some intravenous supplementation until breast milk comes in. The fluid prescription proposed here is inappropriate in volume and composition.
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