In this case study, a newborn is examined to clarify if there are some health problems or complications that to be studied and treated. The vital signs and biometrics turn out to be normal, including the temperature, pulse, respiratory rate, weight, length and head circumstances. Still, several problems, like cephalohematoma and jaundice are observed.
What baseline history about the birth and neonatal course might be important to make an adequate assessment, diagnosis of any problems and plan of continued care for this infant and her family?
To make an adequate assessment and diagnosis and offer a plan of care for this female newborn, it is necessary to identify such points of the baseline history as if any birth-assisting tools were used, and if other traumas were reported during the delivery. Besides, it is necessary to clarify if any family cases of jaundice occurred before.
What are the possible short term or long term sequela of cephalohematoma for this infant?
Cephalohematoma may cause certain short- and long-term outcomes in this infant, which include anemia, hyperbilirubinemia, fibrous, or skull fracture (Auriti, Piersigilli, Lozzi, Di Pede, & Marrocco, 2015). Besides, extravascular hemolysis may be observed (Han, Liu, & Zhang, 2017).
What possible diagnosis could be identified?
One of the possible diagnoses that may be given to the newborn is jaundice caused by a sudden elevated level of bilirubin and changes in the work of the newborn’s liver. In most cases, the signs of jaundice because of cephalohematoma could be observed during the next 1-3 days (Singh, Singh, Sagar, Mehra, & Neki, 2017).
What recommendations would be given this mother about what to expect?
In most cases, children are able to heal their cephalohematomas on their own during the next three months. In this case, the newborn has the symptoms of jaundice, and the newborn’s blood should be tested for the levels of bilirubin. If the results are positive, phototherapy may be offered as the main therapy for the patient (Bhutani et al., 2013).
What additional test might have been done at the hospital on the newborn that you need to review and follow-up?
If parents are concerned about the possible complications, it is offered to use a CT scan or even an MRI additionally to understand what therapies are possible. Still, such scans are not always beneficial for children, and if the situation is clear without such tests, they should be avoided.
What is “yellow” Jaundice the mother is concerned about?
Yellow jaundice the mother is concerned about is the result of the trauma that could occur during the delivery of the child. An injury or a bruise could result in a collection of blood under the scalp and the damage of blood vessels between different layers of the child’s skin. As a rule, no risk to the child’s brain is observed in this case.
What is the differential diagnosis for jaundice in a newborn?
In this case, the differential diagnosis for jaundice in a newborn may be cholestasis that is defined as the changes in the bile flow due to certain obstruction.
What information about this mother and infant might be a risk factor for the jaundice getting worse?
Infant jaundice is a frequent disease in many families. Therefore, it is necessary to know about possible complications that may be caused by the impossibility to control the levels of bilirubin. The mother should be informed about such risks as Kernicterus when the brain is damaged because of high levels of bilirubin or bilirubin encephalopathy that is accompanied by fever and vomiting. It is suggested to address the doctor and take some tests in case the symptoms of the disease undergo no changes, and such risk factors as mother’s diabetes or cephalohematoma are observed.
What tests might be helpful?
In this case, several tests can be helpful to clarify the possible complications and treatment methods. In addition to a physical examination, lab and skin tests should be taken into consideration. A sample of the patient’s blood should be tested, and skin should be tested with the help of a bilirubinometer.
What else significant about this infant did you learn from her exam?
In general, the infant in the case study has good vital signs. Her biometrics correspond with the standards approved by health care organizations worldwide. However, the sclera hemorrhage is the complication that proves that blood vessels are not normal, but damaged and may be ruptured in different ways.
Auriti, C., Piersigilli, F., Lozzi, S., Di Pede, A., & Marrocco, G. (2015). Spontaneous infection of a cephalohematoma associated with sepsis: A case report and revision of the literature. Paediatrics Today, 11(1), 66-70.
Bhutani, V. K., Stark, A. R., Lazzeroni, L. C., Poland, R., Gourley, G. R., Kazmierczak, S.,… & Stevenson, D. K. (2013). Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. The Journal of Pediatrics, 162(3), 477-482.
Han, J., Liu, X., & Zhang, F. (2017). Effect of the early intervention on neonate with hyperbilirubinemia and perinatal factors. Biomedical Research, 28(1). Web.
Singh, K., Singh, P., Sagar, M., Mehra, V., & Neki, N. S. (2017). Incidence, etiological risk factors and outcome of glucose-6 phosphate dehydrogenase deficiency (G6PDD) among neonates presenting with hyperbilirubinemia in tertiary care hospital, Punjab. International Journal of Current Research in Medical Sciences, 3(3), 62-71.