21. Rounding the maternity ward: jaundice in the newborn
Resident: Hi Dr. Jones, I’d like to talk to you about a newborn I’ve just seen. Lucy is two days old and she appears to have jaundice reaching her thighs. She was born at term after a normal pregnancy and a eutocic delivery and didn’t require resuscitation. She has no risk factors for neonatal infection.
Attending: Does everything else seem to be alright?
Resident: Well, she is vital, she has a normal urine output, she passed meconium in the first 24 hours of life and she doesn’t have cephalohematoma or significant bruising. However, she has already lost 12% of her birth weight. She breastfeeds exclusively.
Attending: So what do you suggest?
Resident: I suggest checking the total and the conjugated plasma bilirubin levels, and discarding isoimmune-mediated hemolysis and dehydration.
Attending: OK Jane, go ahead, let me know when you have all the results.
Resident: Dr. Jones, the lab results have arrived. The total plasma bilirubin is 17 mg/dl and the conjugated plasma bilirubin is 0.5 mg/dl. Both the mother’s and the baby’s blood group is A+, so we can discard hemolytic disease of the newborn. The blood gas is normal, but the sodium level is 150 mmol/L, so it seems that the oral intake may not be adequate.
Attending: Very well, so what is your plan with her now?
Resident: I’ve checked the hyperbilirubinemia treatment threshold graph and she needs continuous simple phototherapy, so she needs to be admitted. I’ll teach her mother how to increase breast milk production, and encourage her to express breast milk. On the meanwhile I’ll start Lucy on oral supplements with formula.
Attending: Excellent Jane. Inform Lucy’s parents and prepare the admission. Don’t forget to check the total plasma bilirubin level 12 hours after the phototherapy has started.
Resident: Sure Dr. Jones, thank you for your advice.
Maternity ward: planta de maternidad.
Jaundice in the newborn: ictericia en el neonato.
Born at term: nacido a término.
Eutocic delivery: parto eutócico.
Passed (to pass) meconium: eliminar meconio.
Birth weight: peso al nacimiento.
Isoimmune-mediated hemolysis: hemólisis isoinmune.
Blood group: grupo sanguíneo.
Hemolytic disease of the newborn: enfermedad hemolítica del recién nacido.
Blood gas: gasometría.
Hyperbilirubinemia treatment threshold graph: gráfica de umbral de tratamiento de hiperbilirrubinemia.
Continuous simple phototherapy: fototerapia simple continua.
Express breast milk: extraer leche materna.
Formula: fórmula artificial.