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World J Hepatol. 2017 Sep 18;9(26):1108-1114. doi: 10.4254/wjh.v9.i26.1108.

Conjugated hyperbilirubinemia presenting in first fourteen days in term neonates.

Author information

Gastroenterology Service, Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
Neonatal Medicine, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
Pediatric Gastroenterology, Dubai Hospital, Dubai, United Arab Emirates.



To describe the etiology and characteristics of early-onset conjugated hyperbilirubinemia (ECHB) presenting within 14 d of life in term neonates.


Retrospective review was performed of term infants up to 28-d-old who presented with conjugated hyperbilirubinemia (CHB) at a tertiary center over a 5-year period from January 2010 to December 2014. CHB is defined as conjugated bilirubin (CB) fraction greater than 15% of total bilirubin and CB greater or equal to 25 ╬╝mol/L. ECHB is defined as CHB detected within 14 d of life. "Late-onset" CHB (LCHB) is detected at 15-28 d of life and served as the comparison group.


Total of 117 patients were recruited: 65 had ECHB, 52 had LCHB. Neonates with ECHB were more likely to be clinically unwell (80.0% vs 42.3%, P < 0.001) and associated with non-hepatic causes (73.8% vs 44.2%, P = 0.001) compared to LCHB. Multifactorial liver injury (75.0%) and sepsis (17.3%) were the most common causes of ECHB in clinically unwell infants, majority (87.5%) had resolution of CHB with no progression to chronic liver disease. Inborn errors of metabolism were rare (5.8%) but associated with high mortality (100%) in our series. In the subgroup of clinically well infants (n = 13) with ECHB, biliary atresia (BA) was the most common diagnosis (61.5%), all presented initially with normal stools and decline in total bilirubin but with persistent CHB.


Secondary hepatic injury is the most common reason for ECHB. BA presents with ECHB in well infants without classical symptoms of pale stools and deep jaundice.


Biliary atresia; Cholestasis; Conjugated hyperbilirubinemia; Direct hyperbilirubinemia; Neonatal jaundice

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflict of interest to declare.

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