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How to manage jaundice in child due to Rh incompatibility?

Q: I am asking this question on behalf of my sister. My sister's pregnancy was normal, her blood group is O-, and her husband is A+. I suppose, the child was born with good birth weight - around 9 pounds but with toes angled at 60 degree so they had to put a cast. She didn't have jaundice for 3 days but later developed and since my sister's blood group is Rh -ve, they gave a vaccine for her, but didn't do anything for kid. We were told to keep the kid under sunlight and sent home, but her jaundice went up high and baby had problem sucking and bowel movements, never cried for hours, sometimes for 6 hours. So during her visit with paediatrician, she told everything but the response she got was when baby is hungry she will cry, don't worry. Jaundice prolonged for almost 2 months, now kid is 5 months old where kid cannot hold her neck, no eye coordination, my sister was so much worried, so doctor asked them to get blood test, BAER, EEG etc done. Blood test is normal where as BAER report says enclosed tracing with relevant normal waves found at 90 dB wave 5th not seen 50 dB on left side, findings suggest high frequency hearing loss on left side. EEG report says: EEG is mildly abnormal and finally DMBI hemispheric is dysfunctioning, generalised seizures. Drug sleep EEG with PS background activity PC & FP consist of mixed frequency take 5 Hz (42 to 50 UV), low voltage activity 2.5 Hz (70 to 80 UV), bilateral and symmetric at few times there are generalised birth of sharp and slow waves discharge at 150 to 160 UV, VS non contributor. EEG mild microcephaly, delayed motor milestones. Now kid is undergoing physiotherapy, and on medication. This is my sisters first baby.

A:It seems from case history that the child now has developmental delay, with EEG suggesting seizure activity and microcephaly; and details about serum bilirubin - how much it was is not known, as also if mother had any problems during pregnancy or during labour. As there is Rh incompatibility between mother and child, inj Rh is given to mother to prevent jaundice going high in next pregnancy. The problem now could be due to effect of bilirubin on brain causing damage, hearing often gets affected by high levels. The kid has neurodevelopmental delay and is rightly getting physiotherapy. The kid also needs hearing intervention - the family should consult ENT specialist, for further management - hearing aid + speech therapy, etc. If the head growth is less than normal called microcephaly, it may cause further developmental problems in child and prognosis is guarded. Jaundice lasting two months could be due to hepatitis or prolonged breast milk jaundice - guess only for want of reports. The child might develop cerebral palsy, it is multifactorial, causes can be due to high jaundice level in baby or due to problems during pregnancy, or child birth. At times no cause is found. Your sister should plan next delivery after rehabilitating this child for a year, and delivery should be in a hospital with good neonatal nursery where jaundice can be managed and baby followed by a paediatrician.

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