Posted February 23, 20232 yr hi,a neonate 30days,refer to hospital for icter,bil total 30,direct 20,indirect 10(no kern symptom),your plan!(exchange or no)?if indirect 20 and direct10 ,your plan!(exchange or no)?
February 24, 20232 yr No need for exchange transfusion at this age and with such high direct bilirubin but needs urgent evaluation for biliary atresia.
February 24, 20232 yr No exchange transfusion. Total indirect bilirubin is not that high. but as mentioned above, urgent work up for cholestatic jaundice.
February 24, 20232 yr No exchange required. Check on the color of urine and stools. Investigate for liver pathology and other causes of direct hyperbilirubinemia.
February 24, 20232 yr A few other factors may be important to make that decision. Degree of illness, underlying pathology, Gestational age, BW and postnatal age of the baby. Of course the Threshold for ET will change based on these factors. For example we recently had a full term baby with liver failure due to GALD in which case ET will be needed. However for an otherwise healthy baby with those numbers ET may not be needed. We had a similar vcase of a baby with inspissated bile syndrome. The direct Bili was elevated for over a month!
February 24, 20232 yr 6 hours ago, Katja said: No ExTx. Urgent work up! No i wouldn’t. Most of billirubin is direct. I would look for an hereditary syndrome or an obstrution of bilis like atresia of the biliary system Good luck!
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