Investigation of prolonged neonatal jaundice

How to assess the infant with prolonged jaundice is a common clinical concern for health visitors, general practitioners and paediatricians. Over the past decade in the UK there have been attempts to co-ordinate a national screening programme for extra-hepatic biliary atresia. A reliable methodology would appear to be elusive. Currently, a variety of approaches to screening the baby with prolonged jaundice are being adopted. Most jaundice beyond 2 weeks of age in the term infant is associated with breastfeeding and, as such, is benign. Rarely, however, prolonged jaundice is the marker for a range of haematological, hepatobiliary, metabolic, endocrine, infectious and genetic disorders that are associated with significant morbidity. Thorough clinical assessment is warranted in all cases of prolonged jaundice, but the threshold and range of investigation remain debatable. A reliable diagnosis of breast-milk jaundice can only be made on exclusion of pathological causes. A diagnosis of conjugated hyperbilirubinaemia prompts urgent further investigation. In all cases of 'neonatal hepatitis syndrome' blood coagulation must be assessed if presentation with catastrophic haemorrhage is to be avoided. This article describes 'breast-milk jaundice' and covers several of the more common pathologies that may present with prolonged jaundice. A clinical approach to investigation is provided based on current evidence.