Prolonged jaundice in the preterm infant—What to do, when and why

SummaryProlonged jaundice in premature infants (born at <37 weeks gestation) is a frequent clinical problem. The delay in physiological adaptation following premature birth, together with the promotion of breast milk feeds among neonatal units, increases the age at which non-pathological jaundice subsides compared with infants born at term. Sick premature infants can develop cholestasis because of a combination of factors including parenteral nutrition, delayed enteral nutrition, sepsis, the use of umbilical lines and episodes of hypoxia. This pathological jaundice can become apparent within the first few weeks of life. In addition, premature infants are at risk of developing serious liver disease, including extrahepatic biliary atresia, and their diagnosis and management should not be unnecessarily delayed. The paediatrician needs to be aware that premature infants can present with signs of liver disease at any age after birth, from the first week to well beyond the neonatal period.