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1 month old child, yellow oily stools, prolonged jaundice symptoms, high bilirubin levels. Suggestions?

My 1 month old son has a mixture of mustard yellow and pale yellow stool recently. When I wash him I notice that the stool was oily too. I am very concern as my baby still having prolonged jaundice as at todate even the doctor said it is not severe but I am still worry is there anything abnormal. My baby total serum bilirubin was 11.6 now. Please advice. Thanks!
Asked On : Sun, 4 Nov 2012
Answers:  2 Views:  421
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Pediatrician 's  Response

Thanks for your query.

A serum bilirubin of 11.6 mg% at 1 month of age in a neonate is something to worry about. I suggest that you get him examined by a pediatrician or a pediatric gastroenterologist who may order the following preliminary investigations to assist in coming to a diagnosis:
1. Haemogram
2. Liver function test
3. Urine routine and for reducing substances
4. Whole abdomen ultrasound, if required

It is very difficult to provide a list of possible causes as it is quite vast but based on clinical examination and the above investigations a work-up can be done.

I hope I have answered your query to your satisfaction.

Wishing your son all the best...


Answered: Sun, 4 Nov 2012
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Pediatrician, Neonatology Dr. Arunava Biswas's  Response
The stool type you mentioned, is normal for for your son at this age.

Though the Total Serum Bilirubin (TSB) value of 11.6 mg/dl is higher than normal, it could not be abnormal, as your doctor has examined the baby and suggested so.

Let me clarify the fact in some details.

Jaundice is yellowish discoloration of skin and mucous membrane due to excess of pigment Bilirubin in body. Bilirubin is the product of Hemoglobin degradation after the RBCs in blood die. The type of bilirubin initially produced from Hemoglobin is insoluble in water, it is called the 'unconjugated bilirubin' or 'indirect bilirubin'. Then it is converted to soluble variety by enzymes in liver, and called 'conjugated bilirubin' or 'direct bilirubin'. Body can excrete the soluble variety through kidney (urobilinogen --> Urobilin, in urine) and Bile (stercobilinogen --> stercobilin , in stool) but can not excrete the insoluble variety. Any problem in the path may rise the bilirubin level (direct bilirubin or indirect bilirubin).

Total Serum Bilirubin (TSB) = Direct Bilirubin + Indirect Bilirubin

Causes of jaundice due to increase in direct bilirubin and indirect bilirubin are different.

Causes are -

RBC and hemoglobin defects -- Spherocytosis, Elliptocytosis (hereditary), sickle cell disease, thalassemia, polycythemia
Enzyme defects - Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, Pyruvate Kinase deficiency, Alpha-1-antitrypsin deficiency, Galactosemia
Immunological - Autoimmune hemolytic anaemia,
Systemic - infections, hypothyroidism, TORCH infections, Cystic fibrosis, Gilbert's and Crigler-Najjar Syndrome, side effects of medicines
In neonates (less than 4 weeks age) - Physiological Jaundice (normal), Breast milk and breast feeding jaundice, Blood group incompatibility(ABO and Rh) with mother, Hemolytic Disease of newborn (HDN), cephal hematoma
And IDIOPATHIC - cases where no causes are known.

Besides several such abnormalities, most babies with this bilirubin level are normal.

As, your baby has already been examined by your doctor - possibly he has no abnormalities. It would be better for me to answer, if you could mention the bilirubin fraction (direct and indirect) values.

If bilirubin level persists in higher value, blood G6PD and TSH (thyroid stimulating hormone) level should be tested.

Hope I could make the fact clear. Post if you have further queries.

Answered: Sun, 4 Nov 2012
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