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NeoReviews Vol.10 No.1 2009 e39
© 2009 American Academy of Pediatrics

Index of Suspicion in the Nursery

The first 20% of the full text of this article appears below.


   Case 2 Presentation
 
Twins are born at 32–5/7 weeks’ gestation to a 40-year-old G3P1011 A+ woman by cesarean section because of severe preeclampsia. Serologic maternal test results are unremarkable, including a negative screen for group B Streptococcus. Membranes are ruptured at delivery with clear fluid. Both male infants are delivered uneventfully. Twin A receives Apgar scores of 7 at 1 minute and 8 at 5 minutes. Twin B is assigned Apgar scores of 8 at 1 minute and 8 at 5 minutes. Both babies require nasal prong continuous positive airway pressure at 5 cm H2O for nasal flaring and mild intercostal retractions in the delivery room. On physical examination, both boys are between the 75th and 95th percentiles for birthweight and head circumference and at the 50th percentile for length. Of note, both babies develop jaundice by 1 hour after birth. Twin A has an unconjugated serum bilirubin at 1 hour after birth of 5.5 mg/dL (94.1 mcmol/L), with conjugated bilirubin of 0 mg/dL (0 mcmol/L). Birth hemoglobin was 11.7 g/dL (117 g/L), with a hematocrit of 33% (0.33) and reticulocyte count of 4.8% (0.048). His blood type is A+ with 3+ direct antibody. Twin B has an unconjugated serum bilirubin at 1 hour after birth of 5.0 mg/dL (85.5 mcmol/L), with conjugated bilirubin of 0.1 mg/dL (1.7 mcmol/L). His birth hemoglobin measured 11.0 g/dL (110 g/L), with a hematocrit 31% (0.33) and reticulocyte count of 4.7% (0.047). His blood type is A+ with 4+ direct antibody. Despite being anemic, neither twin appears pale.

Within the first hour after birth, . . . [Full Text of this Article]

Mary Marron-Corwin, MD

Neonatology, St. Vincent's Hospital, New York, NY

Franz Margono, MD

Maternal Fetal Medicine, St. Vincent's Hospital, New York, NY

Milton Meadows, MD

Rady Children's Hospital, San Diego, Calif


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