Station - Instructions for candidate
You are an intern on the postnatal ward of a maternity hospital in Perth. The paediatric registrar has reviewed the baby and asked you to speak with the mother.
Thu Pham has been told her baby's heel-prick test is back and that 'the doctor will explain'.
Baby's details
Born 39+3 weeks by normal vaginal delivery, birth weight 3.4 kg, Apgars 9 and 9; now 60 hours old. Weight today 3.2 kg. Mother O positive, antibody screen negative; baby O positive, direct antiglobulin test negative. Paediatric registrar's examination this morning: well, alert, jaundice to the upper abdomen, no bruising, no hepatosplenomegaly. Phototherapy prescribed.
Serum bilirubin at 60 hours of age (heel prick, this morning)
| Item | Value | Reference range |
|---|---|---|
| Total serum bilirubin | 280 micromol/L | Phototherapy line at 60 hours for a term baby: 270 micromol/L |
| Conjugated bilirubin | 8 micromol/L | <20 micromol/L |
| Transcutaneous bilirubin at 48 hours | 220 micromol/L | Phototherapy line at 48 hours: 250 micromol/L |
| Blood group (baby / mother) | O positive / O positive | Compatible |
| Direct antiglobulin test | Negative | Negative |
| Haemoglobin / reticulocytes / film | 178 g/L / 3% / normal | Hb 140-220 g/L; reticulocytes 2-6% |
| G6PD screen | Sent; result in 48 hours | Normal activity |
Your tasks are to:
- Take a focused history from Thu.
- Explain the bilirubin result and what it means to Thu.
- Explain the diagnosis and the plan to Thu.
- You do NOT need to examine the baby.
- The baby is represented by a doll in a cot; the mother is played by a simulated patient.
This is a 10-minute station, with 2 minutes of reading time.