Neonatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
Pediatrics Department, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal.
BMJ Case Rep. 2024 Feb 14;17(2):e258661. doi: 10.1136/bcr-2023-258661.
Neonatal jaundice is a frequently observed occurrence in full-term newborns and typically manifests between 48 and 96 hours following birth. Early-onset jaundice is primarily induced by pathological factors, namely sepsis, hemolysis and an excessive accumulation of bilirubin resulting from the breakdown of red blood cells.We present a case involving a full-term newborn with an uneventful perinatal history, who exhibited jaundice within the initial day of life and was subsequently admitted to the neonatal intensive care unit to commence intensive phototherapy. Initial screenings for sepsis and blood group incompatibility yielded negative results. However, despite 6 hours of phototherapy, the bilirubin levels did not decrease, prompting an investigation into central nervous system haemorrhage, which uncovered the presence of a haemorrhagic stroke.After a worsening in neurological status with neonatal crisis and need for phenobarbital, a life-saving craniotomy was performed. Clinical evolution was good with no additional crisis detected after the early neonatal period and improvement in motor function at 2-month-old follow-up.
新生儿黄疸是足月新生儿中常见的现象,通常在出生后 48 至 96 小时出现。早发型黄疸主要由病理因素引起,即败血症、溶血性疾病和红细胞破坏导致胆红素过度积累。我们报告了一例足月新生儿,其围产期无异常,在生命的最初一天出现黄疸,随后被收入新生儿重症监护病房开始强化光疗。最初的败血症和血型不合筛查结果为阴性。然而,尽管进行了 6 小时的光疗,胆红素水平并没有下降,因此我们对中枢神经系统出血进行了调查,结果发现有脑出血。在出现新生儿危机和需要苯巴比妥的神经功能恶化后,进行了挽救生命的开颅手术。临床转归良好,在新生儿早期后没有发现其他危机,并且在 2 个月大的随访时运动功能有所改善。