{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:03Z","timestamp":1756318203697,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,20]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>Neonatal hyperbilirubinaemia is a very common entity witnessed in most of the newborns. Rarely are there events where the bilirubin levels reach extreme values mandating invasive therapy. Unconjugated hyperbilirubinaemia when solely present is easy to manage and diagnose the common aetiological factors associated with it. The issue arises when we come across a mixed picture of conjugated with unconjugated hyperbilirubinaemia and puts us in a dilemma as to what are we treating. Our case highlights a similar picture where we witnessed the highest documented levels of total bilirubin but to our surprise the major component of which was direct bilirubin. This report takes us through the differentials which were ruled out and our management strategies for solving this rare mystery.<\/jats:p>","DOI":"10.1136\/bcr-2021-243991","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T12:55:48Z","timestamp":1631624148000},"page":"e243991","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Unusual case of immune haemolytic disease causing severe neonatal cholestasis in a newborn"],"prefix":"10.1136","volume":"14","author":[{"given":"Reema","family":"Garegrat","sequence":"first","affiliation":[{"name":"Neonatology, Bharati Vidyapeeth University, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prince","family":"Pareek","sequence":"additional","affiliation":[{"name":"Neonatology, Bharati Vidyapeeth University, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Snehavardhan","family":"Pandey","sequence":"additional","affiliation":[{"name":"Pediatric Hepatology and Liver Transplant, Sahyadri Hospital, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pradeep","family":"Suryawanshi","sequence":"additional","affiliation":[{"name":"Neonatology, Bharati Vidyapeeth University, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"2025082710525961000_14.9.e243991.1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2008.150714"},{"key":"2025082710525961000_14.9.e243991.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2012.08.022"},{"key":"2025082710525961000_14.9.e243991.3","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1056\/NEJMra1308124","article-title":"Bilirubin-Induced neurologic damage \u2014 mechanisms and management approaches","volume":"369","author":"Watchko","year":"2013","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082710525961000_14.9.e243991.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102223440807"},{"key":"2025082710525961000_14.9.e243991.5","unstructured":"Hansen TWR . 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