Hyperbilirubinaemia, Conjugated

General and supportive measures

Medicine treatment

Surgical treatment

Referral

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Hepatocellular disease	Bile duct obstruction
- hepatitis* - total parenteral nutrition* - syphilis - other congenital infections - galactosaemia*	- bile duct hypoplasia/atresia* - choledochal cyst - cystic fibrosis

* May cause prolonged neonatal jaundice.

Conjugated hyperbilirubinaemia is due to intra/extrahepatic obstruction of bile ducts (cholestasis) and usually presents in the second week of life or later. The baby has a green-yellow skin discolouration, dark bile stained urine and pale acholic stools. Hepatomegaly is commonly present and the infant often fails to thrive.

Neonatal hepatitis, prolonged TPN and biliary atresia or hypoplasia accounts for the majority of cases of conjugated hyperbilirubinaemia.

GENERAL AND SUPPORTIVE MEASURES

• Treat the underlying cause.
• Dietary modifications to counteract the malabsorption of fat and fat-soluble vitamins (A, D, E and K) that may occur in patients with a prolonged conjugated hyperbilirubinaemia.
• When galactosaemia is suspected, avoid lactose-containing feeds, i.e. breast milk and lactose-containing formula.

MEDICINE TREATMENT

All premature babies, day 15 to 1 year:

• Multivitamin, oral, 0.6 mL daily.

SURGICAL TREATMENT

Conditions amenable to surgery, e.g. biliary atresia. Hepatoporto-enterostomy for biliary atresia should be done before 60 days of age for optimal outcome.

REFERRAL

• All cases of jaundice persisting more than 2 weeks with conjugated bilirubin level > 20% of total bilirubin, for diagnosis and initiation of treatment.

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Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter  19: Prematurity And Neonatal Conditions,   19.2 Newborn,   19.2.1.2 Hyperbilirubinaemia, Conjugated