Conjugated Hyperbilirubinaemia in Early Infancy

Abstract

Summary: Conjugated hyperbilirubinaemia exists when the conjugated serum bilirubin level is more than 2 mg/dl or more than 20 per cent of the total serum bilirubin. It is always pathological in early infancy. The causes are many and diverse and most result in cholestasis. Initial diagnostic tests should include tests of liver function, blood and viral cultures, abdominal sonogram, hepatobiliary radionuclide test or duodenal aspiration test to detect the presence of bile in the gut, metabolic screen, and liver biopsy. When carried out early in the course of the disease, these tests will often differentiate between idiopathic neonatal hepatitis and congenital biliary atresia, the two most common causes of conjugated hyperbilirubinaemia in early infancy. While neonatal hepatitis generally requires only supportive therapy, biliary atresia and other mechanical obstruc tions of the hepatobiliary tree require surgery. Unrelieved chronic cholestasis results in fat malab sorption and growth failure, as well as biliary cirrhosis and ultimate liver failure.