Station - Instructions for candidate
You are an intern on the postnatal ward of a maternity hospital in Perth. The paediatric registrar has reviewed the baby and asked you to speak with the mother.
Thu Pham has been told her baby's heel-prick test is back and that 'the doctor will explain'. Everything you need is on your sheet.
| Baby's details | Huong Pham, female, born 39+3 weeks by normal vaginal delivery, birth weight 3.4 kg, Apgars 9 and 9; now 60 hours old on the postnatal ward. Weight today 3.2 kg. Exclusively breastfed 8-10 times a day. Mother O positive, antibody screen negative. Baby O positive, direct antiglobulin test negative. Midwife noted jaundice yesterday. Paediatric registrar's examination this morning: well, alert, jaundice to the upper abdomen, no bruising, no hepatosplenomegaly. Phototherapy prescribed by the registrar. |
|---|---|
| Observations (this morning) | HR 132 /min, RR 42 /min, SpO2 98% on room air, T 36.9 degrees C, weight 3.2 kg (6% below birth weight) |
Results provided:
Serum bilirubin at 60 hours of age (heel prick, this morning)
| Item | Value | Reference range |
|---|---|---|
| Total serum bilirubin | 280 micromol/L | Phototherapy threshold at 60 hours, term, no risk factors: 270 micromol/L |
| Conjugated bilirubin | 8 micromol/L | <20 micromol/L |
| Transcutaneous bilirubin at 48 hours | 220 micromol/L | Threshold at 48 hours: 250 micromol/L |
| Blood group (baby / mother) | O positive / O positive | Compatible |
| Direct antiglobulin test | Negative | Negative |
| Haemoglobin / reticulocytes / film | 178 g/L / 3% / normal | Hb 140-220 g/L; reticulocytes 2-6% |
| G6PD screen | Sent; result in 48 hours | Normal activity |
Your tasks are to:
- Take a brief focused history from the mother about the baby's feeding, output and the pregnancy and birth.
- Explain the bilirubin result and what it means to the mother in plain language.
- Explain the diagnosis, the treatment that has been prescribed, the feeding plan, the follow-up, and the features that should prompt her to seek help; agree the plan with her.
- You do NOT need to summarise your findings to the examiner.
- You do NOT need to examine the baby.
- The baby is represented by a doll in a cot; the mother is played by a simulated patient.
- Plan the station: about 3 minutes for the history and 7 minutes for the explanation.
This is a 10-minute station, with 2 minutes of reading time.