A 6-Day-Old Newborn with Vomiting and Jaundice

Nkechi Okotcha,Jonathan Martin,Raphael Mattamal,Abbie Biggers

doi:10.36013/ijipem.v6i.88

Abstract

Sixty percent of term neonates and 80% of preterms have jaundice within the first week of life. Jaundice can be pathologic or physiologic, indirect, or direct. Indirect jaundice can be neurotoxic at high levels. In its most severe form, this presents as acute bilirubin encephalopathy or kernicterus. Screening for jaundice using a transcutaneous bilirubin check or serum bilirubin has contributed tremendously to the reduction of kernicterus, which ranges from 0.5-1.3/100,000 births. Often, the etiology is easy to decipher. Otherwise, it may be complicated when there are several factors contributing. We present a case of a 6-day-old with jaundice and vomiting who was suffering from intestinal malrotation and a urinary tract infection.

Highlights

Sixty percent of term neonates and 80% of preterms have jaundice within the first week of life [1]
Screening for jaundice using a transcutaneous bilirubin check or serum bilirubin has contributed tremendously to reduced incidence of kernicterus, which ranges from 0.5-1.3/100,000 births [3]
We present a case of a 6-day-old newborn with jaundice and vomiting

Summary

INTRODUCTION

Sixty percent of term neonates and 80% of preterms have jaundice within the first week of life [1]. The patient received phototherapy for about 6 hours Repeat levels showed his total bilirubin was mildly decreased at 20.3 mg/dL and direct bilirubin was 2.7 mg/dL. On DOL 6 the patient was transferred to our regional center for further management due to persisting emesis and increasing jaundice levels despite phototherapy. On admission, his vital signs were within normal limits, and he was on room air. Due to the persisting bilious emesis, a stat upper gastrointestinal x-ray was performed which showed a markedly distended stomach with high-grade obstruction at the level of the transverse portion of the duodenum These findings were suggestive of the presence of malrotation with volvulus or partial small bowel atresia. Such as intestinal atresia, inborn errors of metabolism (including congenital adrenal hyperplasia), hepatobiliary disorders such as biliary atresia, red blood cell disorders, and alloimmune hemolytic disorders of the newborn

DISCUSSION

Findings

CONCLUSION