SNNJ Baby of NASRIAH ADILA BINTI ABD RAHIM-1.pptx

NEONATAL JAUNDICE

1. Severe Neonatal Jaundice KK Tawar JUNE 2023

2. Patient’s details B/O NASRIAH ADILA BINTI ABD RAHIM Address: 68 Kg Binjul Dalam , 09310 Kuala Ketil , Kedah Date of birth: 23/06/2023 @ 0338H Gender: Girl Gestation: 38 weeks 2 days Mode of delivery: Vacuum assisted delivery Birth weight: 3.3kg G6PD: normal ; Cord TSH: 13.59 Mother’s blood group : B positive

3. Patient’s details Para 1 ANC: Mother with chronic hypertension on T. Metyldopa 250mg BD, T. Aspirin 150mg BD, T CaCO3 1g BD 2. GDM on diet control 3. Morbid Obesity BMI 42 4. Mild anemia in pregnancy

4. Risk factors for severe NNJ Risk factors Yes No a Neonatal Jaundice among Siblings / b G6PD Deficiency / c Meconium Aspiration / d Prematurity (< 37/52) / e Low Birth Weight (< 2.5 kg) / f Big Baby (> 4 kg) / g Rhesus negative / h ABO compatibility / i Sepsis (Septic Spot/ Cord Sepsis) / j Cephalohematoma / k Asphyxia / l Others: infant of GDM mother /

5. Chronological event s: Date Time Venue Event 23-24/06/2023 (day 1 - day 2 of life) DBM Hospital, Permatang Pauh Mother and child was discharged from hospital on 24/06/2023 at 4pm. No SBV monitoring done for baby during admission or prior to discharge. 25/06/2023 (day 03 of life) 10.30am (55HR ) KK Tawar SBC 250 (PL@48HR 205, ET 376) clinically jaundice till thighs – referred to Hospital Baling 11.30am Hospital Baling SBV 349 (PL@48HR 205, ET 376) - baby transferred to Hospital Kulim - given intensive phototherapy 26/06/2023 (day 04 of life) Hospital Kulim SBV 282 (PL@72HR 257, ET 410) - given phototherapy 27/06/2023 (day 05 of life) Hospital Kulim SBV 262.3 (PL@96HR 291 , ET 428) - discharged from Hospital Kulim Diagnosis: 1. SNNJ secondary to inadequate feeding 2. PFO/ASD 28/06/2023 (day 06 of life) 9.00am KK Tawar SBC 250 (PL 308, ET428) - baby clinically well, active, tolerating feeding, BO/PU regular 29/06/2023 (day 07 of life) 9.30am KK Kupang SBC 260 (PL 308, ET428) - r eferred to Hospital Baling for rebound jaundice 10.30am Hospital Baling SBV 427.5 (PL 308, ET428) - baby transferred to Hospital Kulim - given intensive phototherapy 30/06/2023 (day 08 of life) Hospital Kulim SBC 287 (PL 308 , ET428)

6. Date Time Venue Event 01/07/2023 (day 09 of life) Hospital Kulim SBV 224 (PL 308 , ET 428) - discharged from Hospital Kulim Diagnosis: 1. Rebound SNNJ 2. Cover for sepsis 02/07/2023 (day 10 of life) 09.00am KK Tawar SBC 198 (PL 308 , ET 428) 03/07/2023 (day 11 of life) 09.30am KK Tawar SBC 195 (PL 308 , ET 428) 04/07/2023 (day 12 of life) 09.00am KK Tawar SBC 208 (PL 308 , ET 428) 05/07/2023 (day 13 of life) 10.30am KK Tawar SBC 203 (PL 308 , ET 428) 06/07/2023 (day 14 of life) 10.00am KK Tawar SBC 192 (PL 308 , ET 428) 09/07/2023 (day 17 of life) 9.00am KK Tawar SBC 190 (PL 308 , ET 428) Breastfeeding, weight gaining, PU/BO normal. Clinically, pink, tinge of jaundice, hydration good, AFNT, physical examination unremarkable. Prolonged jaundice workup done. 18/07/2023 (day 25 of life) 2.00pm KK Tawar Came to review prolonged jaundice workup. Stool inspection: yellow, pigmented. SBV (09/07/2023): T.Bil 205, Direct Bil 8.3( 4%), Indirect Bil 196.7 Hb 16.6 PLT 415 WBC 11.2 retic 1.6% TSH 2.82, T4 15.49 (within normal limit) UFEME: clear 25/07/2023 (day 30 of life) 2.00pm KK Tawar Came for RME 1 month. Breastfeeding, weight gaining, PU/BO normal. Clinically, pink, not jaundiced, hydration good, AFNT, physical examination unremarkable.

7. Pitfalls/substandard care : 1) Patient’s factor : -Nil 2) Healt hcare worker : - Monitoring of SBV not done in postnatal ward and prior to discharge