Monitoring
Conjugated bilirubin measured within the first 24-48 hours of life and even after, should be normal (i.e., <95%). Neonates being investigated for conjugated hyperbilirubinaemia should have prompt follow-up to rule out cholestasis and biliary atresia in a timely fashion.[76]
After discharge from hospital, follow-up guidelines for infants who never received phototherapy are available.[9]
Neonates treated for unconjugated hyperbilirubinaemia should be monitored for total serum bilirubin and haematocrit levels. Increased haematocrit and weight loss of >5% between birth and discharge increases the risk of re-admission to the hospital after discharge for jaundice requiring repeat phototherapy.[94]
In neonates with haemolytic anaemia (secondary to blood group incompatibility), polycythaemia, and extravasation of blood, monitoring for haematocrit levels is important to exclude late-onset anaemia and any ongoing problems in normal bilirubin conjugation and excretion.
Hearing and neurodevelopmental assessments should also be done to identify any residual effects of bilirubin encephalopathy.[46]
Surgical causes of increased enterohepatic circulation need follow-up with paediatric surgeons to ensure proper excretion of bile.
Neonates with partial specific enzymatic conjugation defects need periodic monitoring of total serum bilirubin levels to avoid sustained high values.
Neonates with conjugated hyperbilirubinaemia need monitoring dictated by its aetiology: those with metabolic/genetic defects and clinical syndromes (such as alpha1-antitrypsin deficiency, cystic fibrosis, Zellweger's, Dubin-Johnson, and Rotor's) need follow-up and monitoring by a specialised team that can manage their varied clinical problems in addition to conjugated hyperbilirubinaemia. Neonates with conjugated hyperbilirubinaemia due to hepatitis secondary to infection usually do not require follow-up monitoring once the infection is treated and the hepatitis resolves.
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