Intensive phototherapy successfully treated a newborn with hemolytic disease of the fetus and newborn (HDFN) caused by ABO incompatibility, preventing the need for more invasive interventions like exchange transfusion, according to a case report published recently in the SAR Journal of Medical Case Reports.
The baby, born at 39 weeks, presented with jaundice within the first 24 hours of life and had elevated bilirubin levels. Despite initial concerns about worsening hyperbilirubinemia, careful monitoring with Bilirubin-Induced Neurological Dysfunction scoring ensured that the treatment remained effective and safe. After several days of phototherapy, the infant’s bilirubin levels returned to normal, allowing for a full recovery without complications.
“Diagnosing hemolytic jaundice early and starting phototherapy at the right time is of much importance since bilirubin encephalopathy can lead to permanent neurological dysfunction,” explained the authors. They continued, “Though other treatment options like intravenous immunoglobulins, oral phenobarbitone and metalloporphyrins are available, studies have proven that they all are inferior to phototherapy.”
The newborn was admitted to the neonatal intensive care unit due to respiratory distress at birth, though there was no history of perinatal asphyxia. She required nasal oxygen support and total parenteral nutrition. Initial blood tests revealed neutrophilic leukocytosis and elevated levels of C-reactive protein, prompting the administration of intravenous antibiotics. Within 24 hours, jaundice became apparent. Despite the elevated levels, clinical examination did not indicate an enlarged spleen, and thyroid function was normal.
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The infant’s blood group was B-positive, while the mother’s was O-positive, confirming ABO incompatibility as the cause of hemolytic jaundice. A direct Coombs test was strongly positive, and a blood smear showed signs of hemolysis, including elevated reticulocyte counts and schistocytes.
Following updated 2022 American Academy of Pediatrics guidelines, the baby met criteria for intensive phototherapy. Despite rising bilirubin levels, they remained below the threshold for exchange transfusion. Phototherapy continued uninterrupted, and Bilirubin-Induced Neurological Dysfunction scores were consistently zero, indicating no neurological dysfunction.
After three days, the newborn’s respiratory distress resolved, and she transitioned to breastfeeding. Antibiotic treatment was discontinued once levels of C-reactive protein normalized and blood cultures confirmed the absence of infection. By the fifth day, bilirubin levels had decreased to a safe range, allowing the infant to be transferred to her mother’s care. A 48-hour observation period ensured no rebound hyperbilirubinemia occurred, and she was discharged on the seventh day of life.
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