Bronze baby syndrome (BBS) is a rare complication of phototherapy, one of the treatments used to treat hemolytic disease of the fetus and newborn (HDFN) after birth, and the diagnosis can be challenging as it mimics other complications of HDFN. This was illustrated in a recently published case report in the Index of Suspicion in the Nursery.
BBS is characterized by brown coloration of the skin and bodily fluids such as urine and blood. The exact biological mechanisms behind the disease are not yet fully known.
The condition occurs as a consequence of phototherapy, a form of treatment consisting of exposure to UV lighting to treat increased bilirubin levels (hyperbilirubinemia) that occur as a consequence of red blood cell destruction due to HDFN. Phototherapy can help prevent the neurological damage associated with hyperbilirubinemia.
Learn more about HDFN treatment and care
The case study involved a baby born after 36 weeks of gestation with an HDFN diagnosis due to Rh antigen incompatibility. The patient was born with increased bilirubin levels and an enlarged spleen, which led to the beginning of treatment with phototherapy. A subsequent increase in bilirubin levels induced physicians to start more intensive phototherapy. After a transfusion, bilirubin levels were somewhat decreased.
Shortly after the transfusion, the physicians observed brown coloration of the skin and urine, which was initially thought to be blood in the urine. Still, after a urine exam showed no traces of blood, a BBS diagnosis was made after discarding other metabolic causes.
After diagnosis, phototherapy was stopped with clinical improvement. However, the brown coloration of the skin continued until the baby was 25 days old.
“Considering its benign nature and spontaneous recovery, extensive investigations should not be pursued, if the classic signs are present,” the authors concluded.
