Instructions
You are a medical student on placement on the postnatal ward. You are asked to speak with Thu, whose baby Huong, 60 hours old, has jaundice. The bilirubin result is below.
Take a history from her mother
Explain the result and your management plan to her mother
Huong
Term, normal delivery, 3.4 kg; 3.2 kg today. Mother and baby O positive; DAT negative. Registrar: well; jaundice to the upper abdomen. Phototherapy prescribed.
Serum bilirubin at 60 hours of age (heel prick, this morning)
| Item | Value | Reference range |
|---|---|---|
| Total serum bilirubin | 280 micromol/L | Phototherapy line at 60 hours for a term baby: 270 micromol/L |
| Conjugated bilirubin | 8 micromol/L | <20 micromol/L |
| Transcutaneous bilirubin at 48 hours | 220 micromol/L | Phototherapy line 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 |