Possible causes of hyperbilirubinemia in neonates include ABO blood group incompatibility, newborn septicemia, G-6-PD insufficiency, thyroid dysfunction, and congenital spherocytosis. However, the origin of some cases of hyperbilirubinemia is obscure; acute jaundice might result from several different conditions. The researchers provide a case of severe jaundice with several causes, highlighting the need to determine what triggered the baby’s hyperbilirubinemia so early in life. A male newborn, born at term via vaginal delivery, was brought to researcher’s facility 96 hours after birth because of his yellowish skin tone. There was jaundice and transcutaneous bilirubin of 28 mg/dl when he was admitted to the newborn critical care unit on the fourth postnatal day. It was determined that the total bilirubin level was 540.2 μmol/L and the indirect bilirubin level was 516.7 μmol/L. The baby and both parents had blood types of O Rh(D +), and a direct co-bombs test was negative. Contrarily, a test for indirect Coomb’s disease on the mother was positive. It was discovered that the father had Rh blood type CCDee, the mother had Rh blood type ccDEE, and the infant had Rh blood type CcDEe. Total bilirubin continued to be 303 μmol/L despite intense phototherapy and quadruple volume exchange transfusion. On day 10, the bilirubin level was 303.5 μmol/L, and the patient was given intravenous immunoglobulin once again in addition to rigorous phototherapy. On day 10, the TSH (thyroid stimulating hormone) level was 13.334mIU/L. TSH was measured at 33 mIU/L during testing for congenital hypothyroidism. Ultrasound and MRI were performed because of the abdominal mass that could be felt, and the results revealed a massive tumor in the right adrenal gland. On day 7, an auditory evoked potential was recorded from the brainstem, revealing impairment in hearing (65db for the left ear and 70db for the right). The subsequent treatment was euthyrox and intermittent phototherapy. Not until day 12 did jaundice begin to disappear. Infants born with hyperbilirubinemia should undergo a Coomb test to rule out the possibility of minor blood type incompatibilities, even if the ABO blood group and Rh (d) are consistent.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03594-7