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Q. My granddaughter is 2 months old with persistent jaundice. Please review her reports.

Answered by
Dr. Prakash Nagar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 18, 2020

Hello doctor,

My granddaughter was normally born on 11 April 20. Her birth weight was 2.6 kg, currently weighing 3 kg with persistent jaundice. Her total bilirubin is 3.47 and direct is 3.19. She is breastfeeding along with formula as per pediatrician suggestion with couple of blood tests and ultrasound. The ultrasound was tested for biliary atresia and was negative. I am recently seeing oil in her stools. Pediatrician has evaluated it as conjugated hyperbiliruminemia. It would be nice if you could review and let me know your opinions. Is this could be the reason for not gaining weight?

Dr. Prakash Nagar

Child Health Paediatrics


Welcome to

Persistence of direct bilirubin at two months of age needs to be evaluated properly. Most importantly, what is the color of her stool? Is your doctor told you anything about the liver whether it is big or normal?

There are so many causes, but most important and serious and need timely intervention is extrahepatic biliary atresia which as per information has been ruled out.

Other common causes can be neonatal hepatitis or some metabolic disorder. The list of causes is long so better if you can share all the reports (blood, urine, sonography, Torch titer, TFT, enzymes, alpha 1 anti-trypsin, etc), I can advise you on how to proceed further and whether it needs further investigations.

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Thank you doctor,

Her stool color is normal yellow. We showed the picture to the doctor and her liver is also in normal size. I forgot to tell you in my previous message pediatrician has suggested us give Cardinal drops 2.5 ml at night for clearing bilirubin levels. It is coming down but slowly and her weight is also not gained much.

Dr. Prakash Nagar

Child Health Paediatrics


Welcome back to

As per these blood reports (attachment removed to protect patient identity) and as the color of stool is normal, biliary atresia is unlikely. These reports include liver enzymes and thyroid tests which are normal. It is more probably defect in the clearing of bilirubin from the liver. Thus giving Cardinal needs to be continued but as your baby is not gaining weight, also, in spite of accepting feeds well, then better to rule out other possibilities.

Sonography, Torch titer, alpha 1 anti-trypsin reports are not there. She will require bilirubin uptake and clearance studies if problem persists.

I suggest you check for this test, I expect they must have done it. And if all these are normal, wait and watch for weight gain. Monitor total milk intake, if breastfeeding just weighs the baby once before and after feeding to confirm how much baby is getting (just once only). Monitor regular weight gain, and continue Cardinal.

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