Book of Medical Disorders in Pregnancy - Tintash

the efficiency of this immune globulin
included limited follow up period of 72
hours only.
Prognosis:
Toxic levels of bilirubin can cause
damage when it passes from the serum
into the basal ganglion cells of the brain.
Neurosensory hearing loss is the most
common sequela of excessive serum
bilirubin. Kernicterus is a clinical
syndrome where deposition of unconjugated
bilirubin in certain nuclei of the
brain, affects central nervous system.
The albumin binding capacity is decreased
in conditions where there is
acidosis or history of Sulpho amide administration
and or where free fatty acid
levels are elevated.
These conditions predispose the neonate
to Kernicterus even with lower levels of
bilirubin.
The baby, who develops kernicterus,
suddenly becomes lethargic and stops feeding.
His cry becomes high pitched. The
respiratory rate becomes slow. Apnea,
respiratory, arrest, and even convulsions
may occur in severe cases. Infants who
survive, have severe motor impairment,
including hypotonia, spasticity, and
athetosis.
Mental retardation may occur but it is
generally less severe. In terminal stages,
the babies have irregular gasping
respirations, bloody discharge from the
nose and mouth. Most babies die within
48 to 72 hours.
Mortality or morbidity: Unlike
unconjugated bilirubin, conjugated
134
bilirubin does not bind significantly to
neural tissue and does not lead to
kernicterus or other forms of toxicity.
• The morbidity and mortality associated
with conjugated hyperbilirubinemia
result from the under-lying
disease process.
In certain disease states, such as
alcoholic hepatitis or primary biliary
cirrhosis, bilirubin levels correlate
strongly with, but do not contribute to,
short term mortality.
The Group "0" rhesus negative packed
cells should be cross mulched and found
compatible with mother's blood. The
hemoglobin in these cells should be
around 26 to 28 gram per 100 ml and
hematocrit of 85 to 95 per cent.
The second transfusion could be given
after 10 days and the 3rd and 4th within
3 to 4 weeks interval from the second.
Delivery should be conducted around 34
to 35 weeks.
If on x-ray hydropic fetus with
ascites is found then ascitic fluid is
withdrawn first and mother is given
digitalis and diuretic.
Risks of intrauterine transfusion:
Only 45% of intrauterine transfused
babies are born alive and one third
actually survive.
The risk of immediate death after first
intrauterine transfusion is around 10 to
12 per cent and another extra 5 per cent
with each successive transfusion. The
overall risk is around 7 per cent.
Neonatal death rate in these babies is
around 8 per cent.