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Investigation of prolonged neonatal jaundice
S Hannam1, M McDonnell, J M Rennie
1Department of Child Health, King's College Hospital, London, UK. simonhannam@hotmail.com
Insights
Prolonged jaundice in newborns requires investigation, but many tests are unnecessary. A streamlined screening process focusing on key indicators can safely identify infants with serious conditions.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Diagnostics
Background:
- Prolonged jaundice beyond 14 days in infants can indicate serious liver disease.
- Current investigation protocols for prolonged jaundice lack standardized assessment of screening yield.
- Variability in diagnostic approaches necessitates evaluating screening effectiveness.
Purpose of the Study:
- To prospectively evaluate the diagnostic yield of investigations for term infants with prolonged jaundice.
- To identify a more efficient and effective screening protocol for prolonged neonatal jaundice.
- To assess the necessity of various laboratory and clinical tests in diagnosing underlying conditions.
Main Methods:
- Prospective study of term infants referred for prolonged jaundice over 18 months.
- Comprehensive investigations including serum bilirubin, liver function tests, blood counts, and urine cultures.
- Clinical examination by a pediatrician as part of the screening process.
Main Results:
- 154 infants with prolonged jaundice were referred out of 7,139 live births.
- One infant presented with conjugated hyperbilirubinemia (0.14 per 1,000 live births).
- Diagnoses included giant cell hepatitis, hepatoblastoma, trisomy 9p, urinary tract infections, G6PD deficiency, and failure to regain birthweight.
Conclusions:
- A significant number of infants referred for prolonged jaundice screening have identifiable medical issues.
- Recommended investigations can be reduced to total/conjugated bilirubin, packed cell volume, G6PD level (if applicable), urine culture, and stool inspection for bile.
- Clinical assessment by a pediatrician is crucial for effective screening of prolonged neonatal jaundice.
Unlabelled:
Jaundice persisting beyond 14 d of age (prolonged jaundice) can be a sign of serious underlying liver disease. Protocols for investigating prolonged jaundice vary in complexity and the yield from screening has not been assessed. In order to address these issues, we carried out a prospective study of term infants referred to our neonatal unit with prolonged jaundice over an 18 mo period. Infants were examined by a paediatrician and had the following investigations: a total and conjugated serum bilirubin, liver function tests, full blood count, packed cell volume, group and Coombs' test, thyroid function tests, glucose-6-phosphate dehydrogenase levels and urine for culture. One-hundred-and-fifty-four infants were referred with prolonged jaundice out of 7,139 live births during the study period. Nine infants were referred to other paediatric specialties. One infant had a conjugated hyperbilirubinaemia, giving an incidence of conjugated hyperbilirubinaemia of 0.14 per 1,000 live births. Diagnoses included: giant cell hepatitis (n = 1), hepatoblastoma (n = 1), trisomy 9p (n = 1), urinary tract infections (n = 2), glucose-6-phosphate dehydrogenase deficiency (n = 3) and failure to regain birthweight (n = 1).
Conclusions:
In conclusion, a large number of infants referred to hospital for prolonged jaundice screening had detectable problems. The number of investigations may safely be reduced to: a total and conjugated bilirubin, packed cell volume, glucose-6-phosphate dehydrogenase level (where appropriate), a urine for culture and inspection of a recent stool sample for bile pigmentation. Clinical examination by a paediatrician has a vital role in the screening process.