| Author | 14 Posts |
starry
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2900g term infant develops jaundice at 18hrs of life
infant is well,not lethargic,bfeeding well, PE normal
Bil at 24hrs 12.9mg/dl
direct Bil 12mg/dl
baby is bld gp B+ motheris bld gp O+
what is treatment of choice?
a phototherapy
b exchange transfusion
c cessation of Bfeeding for 2-4 days
d suppl Bfeeding with D5W
e none of the above
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| sp
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photototherapy.
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also check that baby have direct bili may be due ro some obstruction
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| starry
Forum Newbie
Topics: 0
Posts: 2
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I agree that it is phototherapy but i'm a bit worried about the degree of direct hyperbilirubinemia.... with the direct bilirubin so high is phototherapy still an option?
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| hionlyf
Forum Newbie
Topics: 0
Posts: 1
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18 hrs? this is physiologic jaundice. No Rx required
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| alice8
Forum Guru
Topics: 37
Posts: 643
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physiologic jaundice is always indirect hyperbilirubilemy ,breast feeding as well...this child has direct hyperbil....i think there is a problem with liver or after liver..obstruction,biliary atresia ,etc
i go with E.. none of the above
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| 18 hrs?
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I am confused with a Direct fraction of 12, that means the Indirect fraction is .9? The only other thing I can that makes any sense is Biliary Atresia.
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| Rx
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sorry the Rx for Biliary Atresia is Liver Transplant
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| starry
Forum Newbie
Topics: 0
Posts: 2
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since the jaundice is less than 24 hrs it is definitely NOT physiological
the fact that the mother is gp O and the Baby B points to ABO incompatibility as the cause
the problem is that the direct Bil is too high
i think the Q was worded wrongly....
unless it is indeed biliary atresia!!
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| unni
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Hi:
This is NOT physiologic jaundice.
Phys. Jaundice is always with increased indirect bilirubin as it is hemolytic in origin. Also it occurs AFTER 24 hours of life (after the marrow starts HbA production).
This is biliary atresia or other forms of obstructive jaundice.
Nor about Phototherapy:
Phototherapy converts Indirect bilirbin to the easily excreted direct form. Here we have Direct bil and so phototherapy is absolutely useless.
Ans: Exchange transfusion IF it continues to rise
For the time being, ANs: E - none of the above - OBSERVE
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| unni
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Hi :
In the last answer, I wrongly mentioned exchange Tx. It is wrong as it is again direct Bil.
Find the Dx and treat. Biliary atresia means- wait for liver Tx.
Extra hepatic obstruction - correct it surgically
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| mughal
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This is most probably obstuction, like atresia for which the Kasai procedure already exists. Liver transplant would not come till later.
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| md
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anyone interested for phone study for step 3.
Plz e-mail me at mita_chow@yahoo.com
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| sp
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I think U will find this very question in swansons section on jaundice.
However, please check the proportion of dir and indirect bil.
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