Page created on February 20, 2022. Last updated on March 3, 2022 at 13:24
Introduction
For neonatal jaundice, see topic A9 in paeds 1.
The normal upper limit for total bilirubin depends on the age, from < 8 µmol/L for 3 months – 5 years of age to < 24 µmol/L for those older than 11. Subicterus usually becomes apparent at total bilirubin levels >30 – 50 µmol/L, with jaundice developing when the level reaches 250 – 300 µmol/L.
According to the department, direct hyperbilirubinaemia causes a jaundice which is more greenish than the jaundice in indirect hyperbilirubinaemia.
Differential diagnosis in children beyond the neonatal period
| Pathomechanism | Etiology | Typical features |
| Haemolysis | Inherited RBC disorders | Anaemia, non-Caucasian ethnicity |
| Sepsis | Fever, systemic symptoms | |
| Autoimmune haemolytic anaemia | Symptoms of haemolytic anaemia | |
| Drugs (usually antibiotics) | Just started new drug | |
| Malaria | Recent travel to tropics | |
| Impaired bilirubin conjugation | Gilbert syndrome | Mild and transient jaundice, triggered by stress/illness |
| Hyperthyroidism | Tachycardia, diarrhoea, weight loss | |
| Wilson disease | Kayser-Fleischer rings, neuropsychiatric symptoms | |
| Inborn error of metabolism | Hypoglycaemia, muscle pain, exercise intolerance, cardiomyopathy | |
| Viral hepatitis | Tender liver on palpation, risk factors for transmission | |
| Paracetamol overdose | Suicidality, mental health issues | |
| Autoimmune hepatitis | Other autoimmune disorders | |
| Crigler-Najjar syndrome | Rare, normal LFT |