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Biliary atresia — DCH MCQ

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HardNeonatologyBiliary atresiaDCH

A term male infant remains jaundiced at 3 weeks of age. He is feeding well and has regained his birth weight, but his stools have become persistently pale and his urine is dark enough to stain the nappy. Examination reveals mild hepatomegaly. Which is the most appropriate next step?

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Correct answer: E — Measure total and conjugated bilirubin and arrange same-day paediatric assessment

The correct answer is E. Jaundice persisting beyond 14 days in a term infant requires measurement of total and conjugated bilirubin. Persistently pale stools, dark urine that stains the nappy and hepatomegaly strongly suggest cholestasis, including possible biliary atresia, and warrant same-day paediatric assessment even when feeding and growth are satisfactory. Total bilirubin alone cannot identify conjugated hyperbilirubinaemia. Urine culture may be appropriate if urinary infection is suspected but does not address these cholestatic features. A broader liver profile and coagulation studies will follow in secondary care. Ultrasonography is part of subsequent evaluation but should not delay bilirubin fractionation or referral. Breast-milk jaundice does not cause acholic stools or bilirubin-stained urine.

Reference: NICE, Jaundice in newborn babies under 28 days (CG98), section 1.7: Care of babies with prolonged jaundice, updated 2023. https://www.nice.org.uk/guidance/cg98/chapter/recommendations