Initial work-up

For children more than 14 days old -

Split serum bilirubin

Unconjugated - bilirubinaemia

Determine if sudden or gradual onset and when onset

• Blood group
• FBE
• TFT
• G6PD
• Coombs test
• Check the colour of stools - preferably break apart to check that the inner portion is not a light-grey clay-colour.

Conjugated - hyperbilirubinaemia

• Check the colour of stools - preferably break apart to check that the inner portion is not a light-grey clay-colour.

Recommended pre-referral treatment

Unconjugated

Usually a non-gastro cause

• Exclude other causes - ie. breastfeeding may cause unconjugated bilirubinaemia

Conjugated

Usually a liver cause

• Always pathological (ie. biliary atresia, neonatal hepatitis, choledochal cyst obstructing the bile duct).

Well infant

Exclude the above, baby is well and breast-feeding - reassurance that breast-feeding should continue.

When to refer

Unconjugated

Sudden onset (ie. hypothyroidism, infection or red cell enzyme abnormalities - suggestive of haemolysis).

• IMMEDIATE REFERRAL. Call RCH Admitting Officer of General Paediatrics via the Emergency Department on 03 9345 6592.

Conjugated

Call Gastroenterologist on call via RCH switch on 03 9345 5522 if:

• Stool light grey colour (outside or inside of stool).
• Hyperbilirubinaemia.

Well infant

Outpatient referral to General Paediatrics if concerned.

Resources

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

Guideline developed by the RCH Departments of Dermatology and Allergy and Immunology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Nov 2007. Reviewed August 2009.
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