{ "schema_version": 1, "kind": "condition", "id": "prolonged-neonatal-jaundice", "name": "Prolonged neonatal jaundice (beyond 14 days)", "category": "acute", "sources": "Neonatal Jaundice - StatPearls (NCBI Bookshelf NBK532930) - https://www.ncbi.nlm.nih.gov/books/NBK532930/ · Biliary Atresia - StatPearls (NCBI Bookshelf NBK537262) - https://www.ncbi.nlm.nih.gov/books/NBK537262/ · Prolonged neonatal jaundice - disease-level clinical article (prolonged-neonatal-jaundice-full.txt) · Prolonged neonatal jaundice - disease-level clinical article (prolonged-neonatal-jaundice-clinical.txt)", "review_status": "reviewed", "verified_against": "Neonatal Jaundice - StatPearls (NCBI Bookshelf NBK532930) - https://www.ncbi.nlm.nih.gov/books/NBK532930/ · Biliary Atresia - StatPearls (NCBI Bookshelf NBK537262) - https://www.ncbi.nlm.nih.gov/books/NBK537262/ · Prolonged neonatal jaundice - disease-level clinical article (prolonged-neonatal-jaundice-full.txt) · Prolonged neonatal jaundice - disease-level clinical article (prolonged-neonatal-jaundice-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1489, "generic": "Split (fractionated) bilirubin and cholestasis assessment (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Prolonged neonatal jaundice - disease-level clinical article (prolonged-neonatal-jaundice-full.txt)", "rationale": "Jaundice that outlasts two weeks is a laboratory question before it is anything else. The biliary atresia article sets the trigger: past 14 days, jaundice should not be called physiological, and it needs prompt evaluation for cholestatic liver disease. The jaundice article sets the stakes: a conjugated hyperbilirubinaemia in an infant is always pathological, and always points to something medical or surgical underneath. The single test that separates them is the split bilirubin.", "cautions": [ "THE TEST IS A SPLIT BILIRUBIN, NOT A TOTAL. A transcutaneous meter cannot read the direct fraction, and it is that fraction the diagnosis of neonatal cholestasis turns on. (Neonatal Jaundice - StatPearls - NCBI Bookshelf, NBK532930) A transcutaneous reading, or a total serum bilirubin on its own, cannot answer this question.", "WHAT A RAISED DIRECT FRACTION MEANS - the biliary atresia article's laboratory picture is a conjugated hyperbilirubinaemia, with the total and the direct bilirubin both up. (Biliary Atresia - StatPearls - NCBI Bookshelf, NBK537262)", "Suspect neonatal cholestasis readily, read the split bilirubin, the liver enzymes and the imaging without delay, and get the baby to paediatric surgery and hepatology quickly. (Biliary Atresia - StatPearls - NCBI Bookshelf, NBK537262)", "THE REST OF THE WORKUP, as the jaundice article sets it out: the serum aminotransferases can show injury to the hepatocytes where the hyperbilirubinaemia is conjugated; a raised alkaline phosphatase and GGT point to obstruction in the biliary channels; and the prothrombin time (PT), the international normalised ratio (INR) and the serum albumin are the measures of what the liver is still synthesising and how it is functioning. (Neonatal Jaundice - StatPearls - NCBI Bookshelf, NBK532930)", "ASK ABOUT THE NAPPY AND THE URINE - the assessment of a jaundiced newborn opens with a careful history: what complicated the pregnancy, what runs in the family, how the delivery went, when the symptoms started, whether feeding is going well, and the mother's serology. The colour of the stool and of the urine can itself indicate which kind of jaundice this is. (Neonatal Jaundice - StatPearls - NCBI Bookshelf, NBK532930)", "NO PHOTOTHERAPY DOSE IS PRINTED HERE. Unconjugated hyperbilirubinaemia is treated principally by phototherapy and by exchange transfusion - both given as an inpatient, both dosed off a nomogram, and neither a primary-care prescription. A baby who needs them needs a hospital.", "Prolonged jaundice with a NORMAL split bilirubin still needs an explanation. The article's causes of unconjugated jaundice include hypothyroidism present from birth; the sulfa drugs, ceftriaxone and the penicillins; obstruction of the intestine and pyloric stenosis; jaundice of breast milk; and simply not taking enough at the breast. (Neonatal Jaundice - StatPearls - NCBI Bookshelf, NBK532930) Check the newborn thyroid screen before calling it breast-milk jaundice." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "prolonged-neonatal-jaundice" }, { "id": 1490, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Biliary Atresia - StatPearls (NCBI Bookshelf NBK537262) - https://www.ncbi.nlm.nih.gov/books/NBK537262/", "rationale": "Biliary atresia is the reason prolonged jaundice is a time-critical presentation rather than a review appointment, and the window is measured in weeks.", "cautions": [ "RED FLAG - THE THREE SIGNS: biliary atresia usually declares itself in the newborn weeks as jaundice that persists past the second week of life, stools that are pale or without pigment, dark urine, and a large liver. Pale stool plus dark urine in a jaundiced baby is a same-day referral.", "Jaundice together with clay-coloured stools and dark urine means the baby is investigated for biliary atresia and referred properly to a specialist centre.", "THE CLOCK - doing the Kasai procedure early, and ideally before the 60th day of life, is strongly linked to better bile flow, less cholangitis, and a native liver that survives longer. Every week of delay costs liver.", "Operate within 10 weeks of birth and the child is less likely to come to liver transplantation.", "A NORMAL-LOOKING NAPPY TODAY DOES NOT CLEAR IT - the early picture can be faint, and several studies make the point that some infants pass pigmented stool at first, which loses its colour as the bile flow fails; that is one of the reasons the diagnosis arrives late. Ask the family to keep watching the stool colour and to come back.", "GIVE THE PARENTS A COLOUR TO WATCH FOR - organised screening using infant stool colour cards (SCC), as done in Japan, Taiwan, Switzerland, France and Germany, lets parents spot a stool without pigment early and brings the assessment forward.", "REFER, DO NOT INVESTIGATE INDEFINITELY - a baby with neonatal cholestasis goes to a paediatric gastroenterologist without delay.", "RED FLAG - BILIRUBIN ENCEPHALOPATHY, which is the other way a jaundiced baby dies: every jaundiced infant is examined for its clinical signs - feeding poorly, lethargy, a changed sleep pattern, abnormal tone, and fits. And as many as 15% of neonates with kernicterus show nothing clinically in the newborn period.", "Miss pathological jaundice, or leave it untreated, and the result can be bilirubin encephalopathy with the neurological damage that follows it.", "Biliary atresia is not rare enough to gamble on: it is the cause of cholestatic jaundice found most often in the newborn period, and the article's estimate puts it at 25% to 40% of every case." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "prolonged-neonatal-jaundice" } ] }