A rare case of hyperbilirubinemia encephalopathy and sepsis in an infant delivered through lotus births procedure: case report

Abstract Background Home births have a mortality risk 2.6 times higher in domiciliary delivery compared to hospital births, but they allow for the adoption of alternative delivery methods like Lotus Birth (LB). This practice entails preserving the connection between the newborn and placenta by leaving the umbilical cord intact, minimizing the trauma and promoting a gentler separation process for both the mother and the infant. Although research has not established neonatal benefits of LB, documented cases have identified associated risks such us sepsis and physiological jundice, precluding its adoption in hospital settings. The potential link between LB and pathological jaundice remains unclear. Known risk factors for severe hyperbilirubinemia and bilirubin encephalopathy include sepsis, blood-group incompatibility, and dehydration; conditions typically preventable through standard hospital protocols. Case report A male infant born at 40 + 0 weeks of gestational age through a eutocic birth at home by LB was brought to the emergency department on the fourth day of life due to exacerbating jaundice, hyporeactivity, and feeding difficulties persisting for about two days. Laboratory analysis revealed a serum bilirubin level of 51 mg/dL. After admission to NICU infant received intensive phototherapy, IV fluids, exchange transfusion, albumin infusion, IVIG and antibiotic prophylaxis.. The newborn also showed neurological symptoms including muscle stiffness and apparently erratic eye movements, requiring neurological assessment and, during hospitalization, tested positive for COVID-19. Magnetic resonance imaging (MRI) revealed hippocampal changes, and hearing tests yielded pathological results. At one month, the infant was discharged in stable condition but with ongoing neurological and developmental concerns. Conclusion This case highlights the dangers associated with non-evidence-based birth practices (home birth, lotus birth) and the need for vigilant postnatal monitoring. In conclusion, this clinical case delineates a rare yet extremely serious complication of neonatal AB0 incompatibility jaundice, exacerbated by concurrent sepsis and dehydration compounded by inadequate nutrition following lotus birth at home. Upon admission, the neurological examination suggested a diagnosis of severe hyperbilirubinemic encephalopathy. However, confirmation of neurological damage and the subsequent diagnosis of kernicterus were only possible following the performance of MRI.