Neonatal jaundice: unconjugated hyperbilirubinaemia: Case

This late-preterm infant has severe unconjugated hyperbilirubinaemia at 48 hours with multiple compounding risk factors: gestational age of 36 weeks, exclusive breastfeeding with 10 per cent weight loss, jaundice onset before 24 hours, and maternal blood group O. The TSB of 340 micromol per litre is dangerously elevated for a 36-week infant and likely exceeds the phototherapy threshold for a higher-risk infant. The conjugated fraction of 15 micromol per litre is reassuring, ruling out conjugated hyperbilirubinaemia. ^[1]

Clinical findings

The key findings are early-onset jaundice (before 24 hours), rapid progression, significant weight loss from inadequate intake, and a bilirubin level in the high-risk zone. The differential diagnosis includes ABO incompatibility (mother O, infant likely A or B), breastfeeding jaundice from inadequate intake, G6PD deficiency (if at-risk heritage), and hereditary spherocytosis. The initial investigations should include a DAT, blood group, full blood count with reticulocyte count, peripheral film, and G6PD assay if at-risk heritage. ^[3]

The examination should assess for pallor (haemolysis), cephalohaematoma or bruising (enclosed haemorrhage), hepatosplenomegaly (haemolysis or infection), and the infant's general wellness. The cephalocaudal progression of jaundice should be documented, though it is an imprecise tool. The feeding assessment should evaluate latch, milk transfer, urine and stool output, and weight loss trajectory. ^[1]