From the Guidelines
Jaundice in a 2-month-old baby is a medical emergency that requires immediate attention from a pediatrician or emergency room, as it may indicate a serious underlying condition such as biliary atresia, neonatal cholestasis, or other liver diseases. According to a study published in the Mayo Clinic Proceedings in 2017 1, neonatal cholestasis, which is jaundice due to conjugated bilirubin that lasts longer than 2-3 weeks after birth, is due to genetic and/or metabolic causes in about 25% to 30% of the affected patients.
Key Considerations
- The incidence of neonatal cholestasis is 1 in 2500 live births, and it represents a severe medical condition that needs immediate attention and intervention to avoid permanent liver and other organ damage 1.
- Jaundice at 2 months of age is not normal and could indicate potential liver disease, biliary obstruction, infection, or metabolic disorders.
- The doctor will likely order blood tests to check bilirubin levels, liver function, and possibly ultrasound imaging to determine the cause of jaundice.
Recommended Course of Action
- Contact your pediatrician immediately or go to the emergency room if you notice jaundice in your 2-month-old baby.
- While waiting for medical care, continue normal feeding as good hydration helps eliminate bilirubin.
- Watch for warning signs like lethargy, poor feeding, dark urine, or pale stools, which require emergency attention.
- Never attempt home remedies or delay seeking medical care for jaundice in a baby this age, as untreated severe jaundice can lead to brain damage.
Important Facts
- Neonatal cholestasis is usually severe, and the presence of acholic stools makes it challenging to differentiate from biliary atresia 1.
- Some patients may develop cirrhosis early in life; however, jaundice disappears in most patients by 4 months of age.
- Checking for serum levels of a1-antitrypsin could be helpful if used along with the phenotype to distinguish patients who are homozygous for the Z allele or SZ compound heterozygotes, both of whom may develop liver disease 1.
From the Research
Causes of Jaundice in Infants
- Jaundice in infants is caused by an increase in serum bilirubin levels, largely as a result of breakdown of red blood cells 2
- Bilirubin is conveyed in the blood as 'unconjugated' bilirubin, largely bound to albumin, and the liver converts it into a conjugated form which is excreted in the bile 2
- High levels of unconjugated bilirubin are neurotoxic, and phototherapy is a simple and effective way to reduce the bilirubin level 2
Diagnosis and Management of Jaundice
- Most term babies have 'physiological' jaundice which responds to a short period of phototherapy, and requires no other treatment 2
- Any infant with high serum bilirubin or a rapidly rising bilirubin level needs to be treated urgently to avoid neurotoxicity 2
- High levels of conjugated bilirubin in a term baby can indicate biliary atresia, and babies with persisting jaundice must have their level of conjugated bilirubin measured 2
- The management of jaundice in infants and children can be complex, and a concise review of the common medical and surgical causes is necessary for proper diagnosis and management 3
Biliary Atresia and Jaundice
- Biliary atresia is a condition that can cause jaundice in infants, and the Kasai operation is a surgical procedure that can be used to treat it 4, 5
- The use of high-dose steroids, ursodeoxycholic acid, and chronic intravenous antibiotics may improve bile flow and outcome in infants with biliary atresia 4
- The outcome of the Kasai operation can be influenced by various factors, including the age at the time of surgery and the presence of liver fibrosis 5
- Ursodeoxycholic acid treatment may have a beneficial effect on essential fatty acid deficiency in patients with biliary atresia 6