Prolonged neonatal jaundice

Prolonged jaundice is defined as jaundice lasting for longer than:

• 14 days in term infants
• 21 days in preterm infants

The first investigation is to assay the proportion of conjugated bilirubin.

Possible causes include:

• urinary tract infection
• hypothyroidism
• galactosaemia
• breast milk jaundice

NICE suggest (1) that in babies with a gestational age of 37 weeks or more with jaundice lasting more than 14 days, and in babies with a gestational age of less than 37 weeks and jaundice lasting more than 21 days:

• look for pale chalky stools and/or dark urine that stains the nappy
  
  
• measure the conjugated bilirubin
  
  
• carry out a full blood count
  
  
• carry out a blood group determination (mother and baby) and DAT (Coombs' test). Interpret the result taking account of the strength of reaction, and whether mother received prophylactic anti-D immunoglobulin during pregnancy
  
  
• carry out a urine culture
  
  
• ensure that routine metabolic screening (including screening for congenital hypothyroidism) has been performed.

Follow expert advice about care for babies with a conjugated bilirubin level greater than 25 micromol/litre because this may indicate serious liver disease

Reference:

• NICE (May 2016). Jaundice in newborn babies under 28 days - update.