Prolonged jaundice is used to describe neonatal jaundice persisting beyond 14 days of life. At this point the emphasis is no longer on prevention of kernicterus, but on investigation to rule out an underlying abnormality that is causing the jaundice to persist at this point. The overwhelming majority of infants who remain jaundiced at 14 days of age will have benign self-resolving breast milk jaundice. A small number will however have an underlying disorder which requires further evaluation and treatment, principle amongst those is extrahepatic biliary atresia for which the prognosis is improved by early diagnosis.
The testing is based on a risk based clinical assessment followed by targeted investigations, which mean that well breast-fed infants with pigmented stools need just a “split bilirubin” to confirm that the jaundice is all unconjugated- with further investigations if a significant conjugated fraction is detected. Unwell babies, particularly those with pale stools will require a more comprehensive evaluation.
The pathway described below should be used in conjunction with the West of Scotland MCN Neonatal Jaundice Guideline which describes in detail the management of neonatal jaundice including prevention of kernicterus. All acute jaundice issues should be resolved before utilising this pathway.
Aims
- To detect important disorders presenting as prolonged jaundice that require further evaluation
- To avoid over investigation of well babies
- To avoid unnecessary hospital visits for well babies and their families