What should be ruled out if hyperbilirubinemia persists beyond one week?

When hyperbilirubinemia persists beyond one week in a newborn, it is essential to rule out cholestatic jaundice. This type of jaundice is characterized by an impairment in bile flow, leading to the accumulation of bilirubin in the bloodstream. The persistence of elevated bilirubin levels beyond the typical timeframe for physiological jaundice suggests an underlying issue that may affect the liver's ability to process and excrete bilirubin effectively.

In cases of cholestatic jaundice, other symptoms might be present, such as pale stools, dark urine, and signs of liver dysfunction. These symptoms can indicate conditions such as biliary atresia or metabolic disorders, which require timely intervention. Since physiological jaundice usually resolves by one week of age, it is necessary to consider cholestasis when hyperbilirubinemia continues past this timeframe. This is pivotal, as prompt diagnosis and management can significantly impact the child's health outcomes.

While breast milk jaundice and congenital infections can lead to prolonged jaundice as well, they typically present alongside specific clinical features and are less common causes compared to cholestatic conditions. Therefore, focusing on cholestatic jaundice is crucial in guiding further diagnostic evaluations and treatment strategies in persistently jaundiced infants.