This Guidelines summary is based on guidance included within the Children’s Liver Disease Foundation Yellow Alert Pack, written to provide general guidelines on the early identification of liver disease in infants and their referral where appropriate. For further information, please refer to the full guideline.
Early identification of liver disease in infants
Whilst liver disease in infants is rare, early diagnosis is vital. The main indicators are:
You should be aware of the importance of stool and urine colour.
Urine:
Stool:
The interpretation of stool colour can be subjective. The following colour chart will help to overcome this problem.
Algorithm 1: Infant stool chart
First visit
On the first visit midwives and/or health visitors should:
Action in the event of prolonged jaundice
If a child has prolonged jaundice/abnormal stool or urine colour, carry out a general assessment. This includes:
Request the following blood tests:
If the conjugated bilirubin is less than 20% of the total bilirubin and the total bilirubin is less than 200 micromoles/litre, the parent(s)/guardian(s) should be reassured and weekly serum bilirubin levels checked until it is within normal laboratory ranges.
Where the total bilirubin is high (greater than 200 micromoles/litre) and the conjugated fraction is less than 20%, healthcare professionals are advised to contact a paediatrician and refer to NICE neonatal jaundice clinical guideline (CG98) as well as any local guidelines.
The following tests should also be done:
Investigation
Algorithm 2: Early identification
The following should be referred to a paediatrician:
Breast-fed babies may also have liver disease; be extra careful to check stools and urine colour.
Refer to a paediatrician for the following tests:
Referral to specialist centres and advice
If any of the investigative tests are abnormal or liver disease is suspected, the infant may need referral to a specialist unit for further investigations or management. This may be at a regional paediatric gastroenterology unit with an interest in paediatric hepatology or a supra-regional paediatric liver unit.
There are three specialist paediatric liver centres in England; all offer medical and surgical management including transplantation. The Department of Health has designated the three specialist paediatric liver centres to carry out Kasai portoenterostomy for biliary atresia in England and Wales.
Birmingham Children’s Hospital
The Liver Unit, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH
Tel: 0121 333 9999 and ask to liaise with the on-call liver registrar
Secretarial team on 0121 333 8250 (office hours)
Nursing team on Liver Direct 0121 333 8989 or liver.direct@bch.nhs.uk
King’s College Hospital, London
Paediatric Liver, Gastroenterology and Nutrition Centre, King’s College Hospital,
London, SE5 9RS
Tel: 020 3299 9000 and ask to liaise with the on-call paediatric liver registrar
Referrals: kch-tr.PaedLiverRegistrars@nhs.net
Web: kch.nhs.uk/service/a-z/paediatric-liver
Leeds General Infirmary
Children’s Liver and GI Unit, Leeds General Infirmary, Great George Street, Leeds, West
Yorkshire, LS1 3EX
Tel: Admin office on 0113 3925640
Clinical Nurse Specialist Team on 0113 3926151/3926138
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