Overt
umbilical sepsis ( figure ).
Mom had used unhealthy covering for umbilical stump at home.
Hyperbilirubinemic and early features of kernicterus.
| Culture-Related: | Case 1 | Case 2 | Case 3 | Case 4 |
Case 3: Covering the Umbilical Stump of Newborn (by Yeung, Chap-Yung)
| Patient: Infant boy 9 days old |
|
| Source: Hong Kong |
|
| Presenting features: | |
| Increasing jaundice and lethargy for 2 days. | |
| Been observed in hospital for the first 6 days, for being G6PD deficient. | |
| Transient mild jaundice around day 4 which resolved before sent home. |
|
| When examined: | |
|
Mom had used unhealthy covering for umbilical stump at home. Hyperbilirubinemic and early features of kernicterus. |
|
| Diagnosis: |
|
| Umbilical sepsis induced hemolytic jaundice in G6PD deficient infant. |
|
| Progress: | |
| Exchange transfusion was planned but not performed as serum bilirubin declined promptly upon admission. | |
| Sepsis treated with good response. |
|
| Frank kernicterus upon follow-up. |
|
| Lessons: | |
| 1) | Covering the umbilical stump to avoid exposure is a deep-rooted cultural practice, not only in Chinese, but all over South-East Asian communities. |
| 2) | Acute hemolytic jaundice in G6PD deficient subjects occurs frequently in association with infection, such as umbilical sepsis in this case. |
| 3) | Bilirubin level which normally does not produce tissue damage may result in significantly cytotoxicity in the presence of products of infection, such as endotoxin and cytokines. |