The challenge of jaundiced newborns – Unravelling the etiology

511 The attending physician in the nursery examines a jaundiced 20-h-old term, breastfed, white newborn. He is afebrile, nontoxic and well-nourished, weighs 3.8 kg and measures 50 cm, with a head circumference of 34 cm, but has a weak sucking reflex. Though icteric, he has no hepatosplenomegaly and no bleeding signs. His white blood cell count is 11,100 with a normal differential. His hemoglobin is 95 g/L and his platelet count is 258×109/L. Further investigations reveal a serum indirect bilirubin of 200 μmol/L, a negative Coombs test, identical O positive mother-son blood group and a negative glucose-6-phosphate dehydrogenase test (G6PD). Double phototherapy is immediately initiated. The father informs the physician that family members were splenectomized for a blood problem. Final results included microspherocytes with normal mean corpuscular volume, reticulocytosis of 10% of total red blood cells and a positive osmotic fragility test confirming hereditary spherocytosis. The challenge of jaundiced newborns – Unravelling the etiology CPSP HIGHLIGHTS