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BMJ Case Reports 2017; doi:10.1136/bcr-2017-223306
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A rare cause of neonatal persistent jaundice

  1. Alice Mirante2
  1. 1Department of Paediatrics, Hospital Pediátrico de Coimbra, Coimbra, Portugal
  2. 2Department of Paediatric Endocrinology, Diabetes and Growth, Hospital Pediátrico de Coimbra, Coimbra, Portugal
  3. 3Department of Radiology, Hospital Pediátrico de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Gracinda Nogueira Oliveira, gracenoliveira{at}gmail.com
  • Accepted 9 December 2017
  • Published 22 December 2017

Description

A 22-year-old gravida 2, para 1 (G2P1) woman with immunoglobulin anti-D prophylaxis, insulin-treated gestational diabetes and first-trimester cytomegalovirus (CMV) infection vaginally delivered a 39-week boy weighing 3720 g (90th centile) and with Apgar scores of 8 and 10 at 1 and 5 min. Prenatal ultrasonographic assessment throughout gestation was normal. Nursery stay was uneventful. He was discharged on day 2, with a normal examination, except for the appearance of jaundice, with a transcutaneous bilirubin of 248 µmol/L (cut-off 250 µmol/L), not meeting the criteria for phototherapy. A follow-up clinic on day 4, arranged for bilirubin measurement and CMV testing, surprisingly revealed poor general appearance, lethargy, very icteric skin and a minor weight loss (9% of birth weight). Both liver and splenic edges were palpable. Vital signs were normal. Blood routine showed haemoglobin of 19 g/dL, haematocrit of 58%, white blood cells 11.6x109/L and platelet count 128x109/L. Biochemistry revealed total serum bilirubin of 694 µmol/L (cut-off 350 µmol/L), indirect bilirubin of 681 µmol/L, and a normal glucose, urea, creatinine and coagulation study. He was admitted for intensive phototherapy, and his total serum bilirubin level decreased to 289 µmol/L in 9 hours, but rebound hyperbilirubinaemia …

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