Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A one month old boy born of non consanguineous marriage presented with jaundice without clay coloured stools for 3 days. Mother was a chronic carrier of Hepatitis B and had jaundice at 18 years of age. There were no antenatal or post natal complications. On examination, height was 42 cms, weight was 1.75 kg. There was jaundice and hepatomegaly. Others systems were normal. Investigations showed:
• Hemoglobin = 9.5 gm, dl
• WBC = 18,000, cumm
• Platelets = 3,75,000, cumm
• Bilirubin = 15.2 mg, dl {direct bilirubin = 3.2 mg, dl}, SGOT = 106 IU, L, SGPT = 44 IU, L, Total proteins = 7 gm, dl, Albumin = 4.3 gm, dl, Alkaline phosphatase = 293 IU, L.
• PT and PTT = deranged
• TORCH = CMV, Rubella IgG positive
• HIV, Hepatitis C antibody = Negative
• Ophthalmological examination, Hearing test = Negative
• USG Abdomen = Gall bladder seen
• Urine reducing substance = Negative
• Echocardiography = Normal

The baby was given Hepatitis B vaccine and Hepatitis B immunoglobulin within 72 hours of birth.
Expert Opinion :
This child`s neonatal cholestasis resolved on its own. His HBsAg at 6 months of age was negative. Thus Hepatitis B was not the cause of neonatal cholestasis.
Answer Discussion :
Cesar Antonio Ortega
This presentation is most consistant with congenital Rubella given IUGR.
3 years ago
Hepatitis b infection
3 years ago
samed alsalmi
No because indirect hyperbilurebenemia
3 years ago
HanumanthaRao K.R
transplacental transfer of hepatitis B is rare. Perinatal transmission is more common. More ever symmetrical IUGR is not explainable with hepatitits B. This is most probably as a part of neonatal cholestasis syndrome either idiopathic or torch infection
3 years ago
Dr prakash nagar
Its mixed scenario, hepatic derangement with mainly INDIRECT hyperbilirubinemia along with significant IUGR. Possibility of TORCH infection is on the top but in view of indirect hyperbilirubinemia, need to r, o IEM. Better first re-check S. bilirubin - total and direct.
3 years ago
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