Physiological jaundice is defined as: The baby is not premature, jaundice appeared on day 2-4, the baby is well - afebrile, feeding well, alert, passing normal-coloured stools and urine, has no other abnormalities and bilirubin levels are not above treatment threshold.

Initial work-up

• Split (conjugated and non-conjugated) serum bilirubin.
• Normal (non-conjugated) is 85-120 umol/L.
• Check the colour of stools - preferably break apart to check the inner portion is not a light-grey, clay colour.

Recommended pre-referral treatment

• If conjugated bilirubin is >15% of total bilirubin, probably pathological, not just physiological. Needs further investigation.
• Results from the following tests can help with RCH priority and clinic triaging:
  • LFTs
  • TFTs
  • Urine culture
  • Stool colour - Pale light-grey suggests bile duct obstruction and warrantsURGENT REFERRAL by phone to RCH Dept of Gastroenterology - (03) 9345 5060.

When to refer

• Refer if serum bilirubin exceeds:
  • 25-48 hrs = 170 umol/L
  • 49-72 hrs = 260 umol/L
  • >72 hrs = 290 umol/L
• LFT/TFT results - referral dependant on results.

Resources

• Make a referral:Specialist Clinics
• Contacts
• RCH Primary Care Liaison (GP website)
• Kids Health Info (Parent information website)  

References and more reading

• Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 24 (pp369-389) Mark Oliver and Lionel Lubitz. Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by RCH Department of Gastroenterology. First published Jan 2008. Reviewed August 2009. Please read  Copyright and Disclaimer