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Neonatal jaundice — DRCOG MCQ

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HardNeonatal CareNeonatal jaundiceDRCOG

A thriving term infant remains jaundiced at 16 days. The stools have become pale and the urine stains the nappy dark. Total bilirubin is 128 micromol/L and conjugated bilirubin is 38 micromol/L. What is the best next action?

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Correct answer: B — Seek urgent paediatric advice for conjugated hyperbilirubinaemia and investigate neonatal cholestasis

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

D is correct. Jaundice beyond 14 days in a term infant is prolonged, and pale stools, dark urine and conjugated bilirubin above 25 micromol/L require expert advice because serious liver disease or biliary obstruction is possible. E wrongly applies a phototherapy threshold to cholestatic jaundice and delays referral. A interrupts breastfeeding and focuses on unconjugated bilirubin despite red-flag stool and urine changes. B phototherapy does not treat conjugated hyperbilirubinaemia. C delays a time-sensitive cholestasis pathway. Full blood count, blood group, DAT, urine culture where indicated and newborn-screen confirmation form part of the prolonged-jaundice assessment.

Reference: NICE CG98: Jaundice in newborn babies under 28 days—recommendations: https://www.nice.org.uk/guidance/cg98/chapter/recommendations