Haemolytic neonatal jaundice — emergency management station

Emergency management station for haemolytic neonatal jaundice (Rh isoimmunisation). Tests parallel resuscitation, the nomogram-based threshold framework, escalation from intensive phototherapy to IVIG to exchange transfusion, and communication with the mother. Includes assessor key and marking domains.

Prompt

A term infant of a rhesus-negative mother (anti-D positive) is jaundiced at 18 hours of age. Total serum bilirubin 290 micromoles per litre, rising at 14 micromoles per litre per hour. DAT positive. You are the obstetric registrar; the neonatal registrar is 8 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on the postnatal ward. A midwife is with you; the neonatal registrar is 8 minutes away. The assessor will run the clock and feed you new measurements. ^[1]

Candidate instruction. Lead the management of haemolytic neonatal jaundice. Verbalise your threshold framework, your escalation steps, and your communication with the neonatal team and the mother. ^[1]^[2]

References5Show

[1]Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Pediatrics, 2022.PMID 35927462
[2]Wickremasinghe AC, Kuzniewicz MW Neonatal Hyperbilirubinemia Pediatr Clin North Am, 2025.PMID 40619190
[3]Bhutani VK, Maisels MJ, Stark AR, et al. Management of jaundice and prevention of severe neonatal hyperbilirubinemia in infants ≥35 weeks gestation Neoreviews, 2008.PMID 18204221
[4]Patra K, Storfer-Isser A, Siner B, et al. Adverse events associated with neonatal exchange transfusion in the 1990s J Pediatr, 2004.PMID 15126997
[5]Watchko JF, Maisels MJ The enigma of low bilirubin kernicterus in premature infants: why does it still occur, and is it preventable? Semin Perinatol, 2014.PMID 25267279

Haemolytic neonatal jaundice — emergency management station

Station brief

References5Show

[1]Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Pediatrics, 2022.PMID 35927462
[2]Wickremasinghe AC, Kuzniewicz MW Neonatal Hyperbilirubinemia Pediatr Clin North Am, 2025.PMID 40619190
[3]Bhutani VK, Maisels MJ, Stark AR, et al. Management of jaundice and prevention of severe neonatal hyperbilirubinemia in infants ≥35 weeks gestation Neoreviews, 2008.PMID 18204221
[4]Patra K, Storfer-Isser A, Siner B, et al. Adverse events associated with neonatal exchange transfusion in the 1990s J Pediatr, 2004.PMID 15126997
[5]Watchko JF, Maisels MJ The enigma of low bilirubin kernicterus in premature infants: why does it still occur, and is it preventable? Semin Perinatol, 2014.PMID 25267279