Neonatal Jaundice in a Pediatric Patient in Sub-Saharan Africa.
F’s mother brought her to the local health clinic due to yellow discoloration of her skin and eyes, which started on the third day of life and has gradually worsened. The mother also reports that F is feeding less than before and seems more lethargic.
F was born at home via a spontaneous vaginal delivery at full term, with no complications during pregnancy. She is the second child, and her older sibling had no history of jaundice. There is no history of blood group incompatibility testing, and the mother’s blood group is unknown. The baby has been exclusively breastfed, and there have been no issues with stooling or urination.
Vitals: Temperature 36.7°C, heart rate 140 bpm, respiratory rate 40 breaths per minute.
General Appearance: Yellow discoloration of the skin and sclera (jaundice), particularly noticeable on the face and chest.
Neurological Exam: F is lethargic but arousable. Reflexes are sluggish, with decreased activity.
Other Systems: No hepatosplenomegaly or signs of infection. Normal respiratory and cardiovascular exam.
A transcutaneous bilirubin level measured at the clinic was elevated, indicating significant hyperbilirubinemia.
A blood test revealed a total serum bilirubin level of 20 mg/dL, primarily unconjugated.
Blood group testing revealed that F is blood group A+ and her mother is blood group O+, suggesting ABO incompatibility.
A complete blood count showed mild anaemia with a haemoglobin level of 12 g/dL, and a peripheral smear indicated the presence of spherocytes.
F was diagnosed with neonatal jaundice due to ABO incompatibility, leading to haemolysis and unconjugated hyperbilirubinemia.
- Phototherapy: F was started on intensive phototherapy to reduce the bilirubin levels and prevent kernicterus.
- Monitoring: Regular monitoring of serum bilirubin levels was initiated to assess the response to phototherapy and determine if further interventions (such as an exchange transfusion) might be needed.
- Supportive Care: The medical team ensured that F continued breastfeeding with support from lactation consultants to maintain hydration and nutritional status.
- Education: The family was educated about the condition, its potential complications, and the importance of early intervention. They were also informed about the need for close follow-up to monitor for possible neurological sequelae.
With timely phototherapy, F’s prognosis is good. However, in resource-limited settings, delays in accessing treatment could increase the risk of severe complications such as kernicterus, which can lead to long-term neurological damage.
(a). Exclusive breastfeeding
(b). ABO blood group incompatibility
(c). Home delivery
(d). No family history of jaundice
a). Elevated direct (conjugated) bilirubin
b). Elevated unconjugated bilirubin
c). Normal haemoglobin levels
d). Leukocytosis
a). To increase red blood cell production
b). To reduce serum conjugated bilirubin levels
c). To convert unconjugated bilirubin into a water-soluble form that can be excreted
d). To reduce anaemia and promote hydration
a). Serum bilirubin levels not responding to phototherapy
b). Mild jaundice without neurological signs
c). Haemoglobin levels above 15 g/dL
d). Low bilirubin levels with poor feeding
