Direct hyperbilirubinemia caused by severe subgaleal hemorrhage with ischemic liver injury

Abstract

1,2 The prognosis of neonates born with asphyxia can be poor if it is associated with underlying anemia, coagulopathy, metabolic acidosis, or renal impairment. Hemolytic indirect hyperbilirubinemia is one of the minor complications of SGH. 3 We report on a patient who presented with severe direct hyperbilirubinemia after receiving acute intensive therapy such as massive transfusion and continuous hemodiafiltration. Typically, indirect bilirubin levels increase in hemolysis alone, but underlying ischemic liver injury resulting from systemic hypoperfusion was considered to be the likely cause of direct hyperbilirubinemia in the present patient. The pathogenetic mechanism of this condition and the management are discussed. Case report A girl was born at 41 weeks 4 days gestation, weighing 3656 g, by spontaneous vaginal delivery. The mother was 45 years old with a history of five pregnancies and five live births, of which the first delivery was by cesarean section and four were vaginal. The third boy had acute subdural hematoma of unknown cause at 1 week of age and died of aspiration pneumonia during the chronic stage. He had no definite bleeding diathesis. The mother’s blood type was O positive and she had experienced rubella. Hepatitis B surface antigen and a serologic test for syphilis and rubella were negative. No abnormality was noted during the course of the pregnancy, but her second delivery stage was delayed due to persistent deep transverse arrest, and fetal heart rate began to decrease just before birth. Because the fetal head did not come down after several attempts of vacuum extractions, forceps were used to achieve vaginal delivery.