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Biliary atresia — RACP Paediatrics MCQ

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HardNeonatologyBiliary atresiaRACP Paediatrics

A 3-week-old infant has persistent jaundice. He is thriving but the parents report pale stools and dark urine; examination shows hepatomegaly. Total bilirubin is elevated and the urine dipstick is positive for bilirubin. What is the most appropriate investigation?

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Correct answer: D — Fractionated bilirubin with urgent hepatobiliary assessment

Pale stools, dark urine and hepatomegaly indicate conjugated hyperbilirubinaemia, and biliary atresia must be excluded urgently because surgical timing affects outcome. Repeating total bilirubin alone risks delay and does not distinguish conjugated from unconjugated jaundice. The pearl is that prolonged jaundice beyond 2 weeks in a term baby requires split bilirubin, and pale stools are a red flag.

Reference: RCH Clinical Practice Guidelines: Jaundice in early infancy; Therapeutic Guidelines (eTG)