A baby on the post-natal ward developed jaundice at 32 h of age. She was born at term, weighing 3300 g, to a 25 year-old mother with a healthy 5 year-old daughter. Mother was breastfeeding. The membranes had ruptured 28 h before delivery. No antibiotics were given to mother or baby.
Examination of the baby was normal, apart from jaundice. The weight was 3100 g. The serum bilirubin level was 19.5mg/dL. Mother was blood group O Rhesus negative; baby A Rhesus negative The direct Coombs test was weakly positive Hb 15.4 g/dL, white count 16700/dL (60% neutrophils) and platelets 212000/L
1. What is the most likely diagnosis?
A. Rhesus haemolytic disease
B. Dehydration jaundice
C. Neonatal infection
D. Breast milk jaundice
E. ABO incompatibility
2. What other investigations are necessary?
A. Conjugated/unconjugated bilirubin levels
B. Urea and electrolytes
C. Glucose-6-phosphate dehydrogenase levels
D. Osmotic fragility test
E. None of above
3. What is the correct treatment?
A. Withdraw breast feeds
B. Phototherapy and Penicillin and gentamicin
C. Double-volume exchange blood transfusion
D. Just phototherapy
E. No need of any therapy
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