prolonged neonatal jaundice

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Prolonged jaundice is defined as jaundice lasting for longer than:

  • 14 days in term infants
  • 21 days in preterm infants

The first investigation is to assay the proportion of conjugated bilirubin.

Possible causes include:

  • urinary tract infection
  • hypothyroidism
  • galactosaemia
  • breast milk jaundice

NICE suggest (1) that in babies with a gestational age of 37 weeks or more with jaundice lasting more than 14 days, and in babies with a gestational age of less than 37 weeks and jaundice lasting more than 21 days:

  • look for pale chalky stools and/or dark urine that stains the nappy

  • measure the conjugated bilirubin

  • carry out a full blood count

  • carry out a blood group determination (mother and baby) and DAT (Coombs' test). Interpret the result taking account of the strength of reaction, and whether mother received prophylactic anti-D immunoglobulin during pregnancy

  • carry out a urine culture

  • ensure that routine metabolic screening (including screening for congenital hypothyroidism) has been performed.

Follow expert advice about care for babies with a conjugated bilirubin level greater than 25 micromol/litre because this may indicate serious liver disease

Reference:

Last reviewed 01/2018

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