Page created on February 20, 2022. Last updated on March 3, 2022 at 13:24
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
|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|