Contents Chapter Topic Page Neonatology Respiratory Cardiology

a. If unconjugated hyperbilirubinaemia,
Admit if SB is >300umol/L or child unwell. Otherwise follow-up with weekly SB.
Important investigations are; Thyroid Function Tests, Urine FEME, C&S and reducing
sugar, and FBC, Retic count & Film
Exclude UTI and Hypothyroidism.
Congenital Hypothyroidism is a neonatal emergency. (Check Screening TSH
result if done at birth). See protocol on Congenital Hypothyroidism.
FBC to be done for AB0, G6PD deficiency and Rh incompatibility at 6 weeks to look
for anaemia. KIV Haematinics.
Breast milk Jaundice is a diagnosis of exclusion. Child must be well, gaining
weight appropriately, breast-feeds well and stool is yellow. Management is to
continue breast-feeding. There is a need to tell the parents that the jaundice is likely
due to BM but it is usually of no harm and conversely may confer benefit as bilirubin is
a strong anti-oxidant. Rarely, if the SB is too high (i.e. 25 mg%) then withdrawal of BM
for 48 hours may be appropriate after which breast-feeding should continue. In the
meantime the mother should express her milk to ensure her supply does not diminish.
b. If conjugated hyperbilirubinaemia (conjugated bilirubin > 2mg%)
Admit and observe colour of stool for 3 consecutive days. Further investigations
should include LFT, Hep B and C status, TORCHES and VDRL tests
Start phenobarbitone on admission at 5 mg/kg OD for 5 days to prime the liver for
HIDA scan if eventually required.
If the stool is pale over 3 consecutive days, suspect biliary atresia, and refer to
paediatric surgery. Plans should be made for :
a) Ultrasound of liver
Preferably done after 4 hours of fasting, dilated intrahepatic bile ducts and absent
gall bladder is highly suspicious of extra hepatic biliary atresia.
b) HIDA Scan (if available) after 5 days of phenobarbitone.
Slow uptake with normal excretion: Neonatal Hepatitis syndrome.
Normal uptake with absent excretion: EH Biliary Atresia
c) Liver biopsy (hardly ever done now)
With a good pathologist biliary atresia can be confirmed in 85% by biopsy.
Ensure PT and aPTT normal. If not give Vit K 1 mg IV.
Platelet count at least 40 000
d) Operative Cholangiogram followed by definitive surgery if necessary.
This is now the investigation of choice in most centres.