Patient: 8 week old boy
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Source: Canada, 2001
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| Presenting features: |
| |
Full-term infant born normally following an uneventful first pregnancy.
Discharged home on Day 2 on breast feeding. |
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Jaundiced on Day 5. Seen by pediatrician on Day 7. Noted to have high
serum bilirubin ( >380 µmol/L ). No active treatment apart from
phototherapy. Discharged on Day 9. |
| |
Mom noticed poor feeding and frequent regurgitation on returning home.
Frequent high-pitch cries and arching of back. Irritable and poor sleeping
at night.
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| When seen ( 8/52 ): |
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Opisthotonic posture, more marked when agitated. |
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Jittery limb movements ++; moro reflex depressed. |
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Poor rooting and sucking. No jaundice.
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| Dx: |
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Kernicterus ( sequalae of bilirubin encephalopathy )
|
| Relevant Investigations: G6PD deficient |
| |
Retrospective survey at home revealed use of naphthalene as insect repellant.
|
| Lessons: |
| 1) |
Kernicterus is well-known to occur
in Chinese term infants even beyond the first week of birth - very different
from most teaching in English literature. |
| 2) |
Acute hemolytic jaundice occurs spontaneously
in G6PD deficient infants, many hidden precipitating factors in the Chinese
house-holds are often ignored. They include taking of certain herbs, ( especially
Chuen-Lien ), exposure to vapor of naphthalene ( moth-balls ), and overt
or sub-clinical ( bacterial overgrowth ) infection ( especially in unhygienic
home environment ). |