Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- gastrointestinal bleeding
- acute liver failure
- sepsis in a patient with liver disease
- encephalopathy in a patient with liver disease
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 - appointment clinically indicated within 30 days
- conjugated serum bilirubin (SBR) > 20% two weeks post-partum
Category 2 — appointment clinically indicated within 90 days
- nil
Category 3 — appointment clinically indicated within 365 days
- nil
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- for adult patients, relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- for paediatric patients, identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
History
- past medical/surgical history, including cardiac history
- family history of liver disease or diabetes
- onset, duration, and progression of symptoms
- current/previous medications and dosages, including supplements
- use/ frequency of alcohol, tobacco, and other drugs
- allergies and sensitivities
- management history including treatments trialled/implemented prior to referral
- child/parent demographic information, including best contact details
- antenatal course
- birth history e.g. gestational age, birth trauma, instrumental delivery
- feeding history e.g. breast/formula/nasoenteric feeding
Examination
- abdominal examination results
- height/weight, including any weight loss
- output (urine/stools) e.g. hydration status, dark urine and pale stools
Investigations
- total serum bilirubin (SBR):
- unconjugated (indirect)
- conjugated (direct)
- complete blood examination (CBE)
- direct antiglobulin test (Coombs)
- neonatal blood group
- maternal blood group and antibodies titres
- liver function test (LFT)
- glycated haemoglobin test (HbA1c) OR blood glucose level (BGL)
- thyroid function test (TFT)
- c-reactive protein (CRP)
- maternal infectious serology
- ultrasound (lesion) report (US), if gall bladder involvement suspected
Additional information to assist triage categorisation
- liver elastography and/or other relevant imaging reports
- urine culture may be indicated where there is faltering growth but is not a routine test in prolonged jaundice
Clinical management advice
With current standards of perinatal care the great majority of babies who develop clinically significant jaundice will do so after discharge from hospital.
Prematurity, weight loss due to inadequate breast milk intake, and lack of recognition of jaundice leading to delays in presentation and treatment are common factors described in cases of kernicterus.
Referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but may not fit the criteria provided, you are encouraged to contact the specialist team to discuss your concerns.