A baby still jaundiced after two weeks of age needs blood tests today — not reassurance. Pale, chalky stools and dark urine in a jaundiced baby are urgent. Ask for a split bilirubin test rather than waiting to see if the jaundice fades.
The bile ducts carrying bile out of a baby's liver are blocked or absent. Bile accumulates and destroys the liver within months. It is the commonest reason a baby needs a liver transplant.
Written for parents. One message matters more than the rest: the window for the operation that can save the baby's own liver closes at around eight weeks of age, and every week counts.
Bile is made by the liver and drains through ducts into the intestine, where it helps digest fat and gives stool its normal colour. In biliary atresia those ducts are progressively destroyed, blocked or absent from birth. Bile cannot escape, and it damages the liver from within.
Babies with biliary atresia usually look well at birth and feed normally. Jaundice appears or persists in the first weeks, but newborn jaundice is common and usually harmless, which is exactly why this condition is diagnosed late so often.
The distinguishing signs are pale, chalky or clay-coloured stools and dark urine. Normal newborn jaundice does not change stool colour. If a baby is still jaundiced beyond two weeks of age, a split bilirubin test — measuring conjugated as well as total bilirubin — separates harmless jaundice from this.
The reason timing matters so much is the Kasai portoenterostomy, an operation that connects a loop of intestine directly to the liver surface to allow bile to drain. Performed before around eight weeks of age it succeeds far more often than later. Even where it works, many children eventually need a transplant — but it can buy years of growth first.
The Kasai operation succeeds far more often when performed before about eight weeks of age, and its success rate falls steadily after that. The commonest reason for delay is that persistent jaundice in a baby is attributed to breast milk jaundice and observed rather than investigated. If your baby is still jaundiced at two weeks, ask specifically for a split bilirubin test. A raised conjugated bilirubin means the problem is obstruction, and that needs assessment the same week — not at the next routine appointment.
One blood test separates harmless jaundice from this, and it is quick.
It sounds crude and it is genuinely useful. A photograph of the stool in good natural light, alongside your baby's exact age in weeks, the split bilirubin result and the ultrasound report, lets a paediatric hepatologist form a firm view very quickly. Pale, putty-coloured stool in a jaundiced baby is close to diagnostic on its own.
The first operation tries to save the baby's own liver. Transplant follows where it cannot.
The blocked ducts are removed and a loop of intestine attached directly to the liver surface so bile can drain. Performed before around eight weeks it succeeds in a substantial proportion of babies, clearing jaundice and allowing years of normal growth. Success falls sharply with age at operation, which is why speed matters so much.
Babies with biliary atresia cannot absorb fat normally and need special formula with medium-chain triglycerides plus supplements of fat-soluble vitamins A, D, E and K. Vitamin K deficiency causes bleeding and is dangerous. Good nutrition before transplant substantially improves the outcome afterwards.
A segment of a parent's liver is transplanted. It is the definitive treatment where the Kasai operation has failed or was performed too late, and results in experienced paediatric centres are very good. Under Indian law the donor must be a near relative with embassy certification and Authorisation Committee approval.
Recurrent infection of the bile ducts needs prompt antibiotics. Portal hypertension may cause variceal bleeding requiring endoscopic treatment. Growth and development need close monitoring, because a child who grows well tolerates transplant far better.
Under eight weeks, Kasai is attempted. Considerably later, transplant assessment may be the more realistic path from the outset.
Persistent jaundice three months after Kasai generally indicates it has not worked and transplant planning should begin.
A well-nourished child does far better through transplant. This is not a side issue; it is part of the preparation.
If your baby is under eight weeks and this is suspected, do not wait for us. Ask your local hospital for urgent paediatric surgical referral today — the operation may be possible where you are.
A baby under eight weeks with suspected biliary atresia needs local paediatric surgical assessment immediately. Do not spend that window arranging travel.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
It needs a blood test rather than reassurance. Most prolonged newborn jaundice is harmless breast milk jaundice, but a split bilirubin test distinguishes that from obstruction in minutes. Raised conjugated bilirubin means investigation is urgent. Pale stools and dark urine make it more urgent still.
The blocked ducts are removed and a loop of intestine joined directly to the liver surface so bile can drain into the gut. It does not cure the condition but can restore drainage and allow years of normal growth. Its success depends heavily on the baby's age — before around eight weeks it works far more often than later.
Many do, eventually. Kasai buys time and growth rather than providing a permanent cure, and a proportion of children require transplant during childhood or adolescence. Some do well for many years with their own liver. Either way the operation is worth doing when the window allows, because a bigger, better-nourished child comes to transplant in far better condition.
Yes, and in paediatric liver transplant a parent is usually the donor, giving a small segment of their liver. Under Indian law the donor must be a near relative with the relationship certified by your embassy and the case approved by an Authorisation Committee. A parent qualifies. Start the paperwork early — it is often the slowest part.
Without bile reaching the intestine, fat and the fat-soluble vitamins A, D, E and K cannot be absorbed properly. Special formula containing medium-chain triglycerides bypasses much of that problem. Vitamin K deficiency in particular causes serious bleeding, so supplementation is essential rather than optional.
The jaundice clears and the stools return to normal colour, usually within the first three months after the operation. Persistent jaundice at three months generally indicates it has not succeeded, and transplant planning should begin at that point rather than later.
Send the split bilirubin result, your baby's exact age in weeks, and a photograph of the stool. Those three together tell a paediatric hepatologist a great deal.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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