Aim To establish the incidence of conjugated hyperbilirubinaemia over a 4 years period in a tertiary neonatal unit and to review the demographic data, the investigations and treatments they received.

Method A retrospective observational study between 01/06/2010 and 28/02/2014. Data was retrieved from the neonatal database BADGER. Search term: conjugated hyperbilirubinaemia or ursodeoxycholic acid.

Result Less than 1% (40/5237) admissions to the neonatal unit had conjugated hyperbilirubinaemia. 70% were less than 33 weeks gestation. 60% weighed less than 1251g. 33 infants (82%) received total parenteral nutrition (TPN). Variable numbers of babies were investigated for different conditions (24 infants had TORCH screen, 15 infants had a1 antitrypsin level, 13 infants had Gal-1-p level, 25 infants had abdominal ultrasound scan and 26 infants had urine metabolic screen). Regarding diagnosis: 18 babies had TPN related cholestasis, 3/40 had biliary atresia, one had choledochal cyst. 3/40 had liver failure. All babies received ursodeoxycholic acid and 80–90% had vitamin supplements (vitamin K, E, and/or dalavit). 27 babies were referred to the liver team.

Conclusion Conjugated hyperbilirubinaemia is rare on neonatal units. Infants who are less than 33 weeks gestation and less than 1251g are most at risk. The majority were diagnosed with TPN-associated cholestasis. It is important to develop guidance for diagnosis and treatment for conjugated hyperbilirubinaemia in the neonate to ensure cost effectiveness of a more streamlined investigation plan, limiting discomfort and risk of anaemia for babies and also consistency in management.