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Conjugated hyperbilirubinaemia — RACP Paediatrics MCQ

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HardNeonatalConjugated hyperbilirubinaemiaRACP Paediatrics

A 3-week-old breastfed infant remains jaundiced. Total bilirubin is 210 µmol/L with a conjugated fraction of 80 µmol/L (38%). The infant is well and growing. Stools are described as pale. What is the most appropriate next step?

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Correct answer: E — Investigate for conjugated hyperbilirubinaemia

Conjugated (direct) bilirubin >20% of total bilirubin is always pathological. Pale stools in a jaundiced infant raise concern for biliary atresia, which requires urgent investigation (urgent ultrasound and referral to paediatric hepatobiliary surgeon). Kasai portoenterostomy outcomes are best when performed before 60 days of age.

Reference: RCH Melbourne – 2023 – Jaundice in Early Infancy CPG; RACP Paediatric Curriculum – Neonatology/GI