Clinical Case Reports

Biography

Biography: Khalid Iqbal

Abstract

The common cause of early neonatal hyperbilirubinemia is pathological hyperbilirubinemia due to hemolytic disease. Mostly neonatologists rule out the common causes of early severe hyperbilirubinemia, Rh or ABO incompatibilities, G6PD deficiency and occasionally sepsis. The congenital hypothyroidism has been recognized since long as a cause of prolonged jaundice but early neonatal severe hyperbilirubinemia requiring exchange transfusion is rarely considered to be caused by congenital hypothyroidism. We managed a case of severe early neonatal hyperbilirubinemia (33.9mg/dl) who required twice exchange transfusion and investigations proved a case of congenital hypothyroidism and treated with Thyroxin and follow up in clinic showed no neurological deficit. This is a very rare case where early hyperbilirubinemia was severe enough requiring exchange transfusions and could not find similar case report. There are related reports from different parts of the world. One study reported twelve cases in which congenital hypothyroidism were associated with significant neonatal jaundice. Out of twelve, three neonates presented with excessively severe jaundice in early neonatal period within first week of life and maximum bilirubin level was 22mg/dl. Another study had reported five cases of congenital hypothyroidism with severe early neonatal hyperbilirubinemia within five days of age and maximum bilirubin was 25.8mg/dl. However, it is unusual to have such severe early neonatal hyperbilirubinemia requiring exchange transfusion caused by congenital hypothyroidism. Because usually the features of congenital hypothyroidism are minimal at this early neonatal age, it would be ideal to perform thyroid function tests in all babies with unexplained hyperbilirubinemia. If screening of newborns for hypothyroidism is not the routine, serum thyroxin and thyrotropin should be measured in any infant who present with unexplained unconjugated hyperbilirubinemia. This is of profound importance because congenital hypothyroidism is one of the preventable causes of mental retardation if treated early preferably within 2 weeks of life