Question

Hi I have a 7 days old neonate admitted with me with complaint of neonatal icterus. This male baby was delivered by C-section(indicated for prolonged labour and leaking membranes) at full term. He cried and gasped after about 1 1/2minute and had an Apgar score of 10/10 at 3minutes. Mother's blood group is O-positive and baby is B-positive.The baby developed jaundice after 24 hours. DCT was negative and se Bil was T-11.2 and direct- 1.8 mg.G 6PD normal,Retic count 1.8% and HB -12.8gm.C.B.C is normal. There was no sign of sepsis as baby was active and accepting feed well. The baby was started on Omnatax and mikacin for PRM and put under Phototherapy. subseq . Bilirubin reports are as follows. Age in hrs. Total Direct 36 12.6 1.6 48 19.2 1.8 54 18.2 1.6 60 17.7 1.7 72 17.4 1.6 96 17.6 1.7 120 17.2 1.5 After this inspite of double surface continous Phototherapy ,the total Bil is persisting at 17.6 and direct 1.8 even on day 7. Should we do an Exchange transfusion or continue with Phototherapy?In case if we want to do an exchange which vein will be available as by this time the Umblical vein must be obliterated? Dr. JS Chugh