Conjugated Hyperbilirubinaemia of the Newborn
Go straight to conjugated hyperbilirubinaemia algorithm
This becomes significant if the direct reacting bilirubin is >25 micromol/L in the first few days of life or >= 20% of the total bilirubin. The liver is sometimes enlarged, the urine is dark and the stools pale. There may be evidence of spontaneous bleeding due to vitamin K malabsorption. By far the commonest cause is hepatitis but because some causes are surgically correctable (biliary atresia and choledochal cysts) it is important to arrive at an early diagnosis. Prognosis is significantly better if surgical intervention is in the first 4-6 weeks of life.
A modified version of Dr Sandhia Naik's (consultant paediatric hepatologist) conjugated hyperbilirubinaemia algorithm is below. Contact her for further advice once you have the results of her suggested first line investigations. She will advise on second and third line investigations.
In a large number of patients the cause of conjugated hyperbilirubinaemia is not found. It is worth remembering that parenteral nutrition may be associated with the condition although the offending substance(s) are unknown.
