الفهرس 
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Abstract
Prolonged jaundice can be defined as yellowish discoloration of skin and mucous membranes after 14 days in term neonates, and 21 days in preterm neonates. Distinguishing between conjugated and unconjugated hyperbillirubinemia is important to establish diagnosis.
Unconjugated hyperbillirubinemia is defined as a conjugated billirubin level <20% of total billirubin. The most common cause of which is breast-milk jaundice, with a reported incidence of 36% in the third week of life. Some pathological conditions can also cause prolonged unconjugated hyperbillirubinemia as hemolytic diseases (due to Rh or AB0 incompatibility, or G6PD deficiency),urinary tract infection ”UTI”, Crigler-Najjar or Gilbert syndromes.
Prolonged conjugated hyperbillirubinemia is defined as a conjugated billirubin level >20% of the total billirubin, it is only related to the neonatal causes of cholestatic liver disease such as biliary atresia, hepatitis and metabolic disorders.
This study was a cross-sectional study, conducted on 55 neonates with prolonged neonatal jaundice from November 2017 to July 2018 in Neonatal Intensive Care Unit (NICU) and out-patient clinic of Menoufia University Hospital and Benha Children Hospital.
We have excluded from our study the cases of neonatal septicemia or meningitis or encephalitis. Also, we excluded babies with chromosomal disease or congenital anomalies. All cases were subjected to full detailed history taking, Meticulous clinical examination was done to all cases includes general and local examinations.
Investigations were done to all cases including laboratory investigations as complete blood count, c-reactive protein , total and direct serum billirubin and ALT,AST, blood group and RH for babies and their mothers and urine analysis using urine bag and under complete aseptic technique for microscopic examination. Radiology was done only to cases with direct hyperbillirubinemia in the form of abdominal ultrasonography .
The age of all cases ranged from 14th day to 49th days, (32 males ”58%”and 23 females42%), 89% born by cesarian section delivery while 11% by normal vaginal delivery.
The percentage of fullterm (≥37 weeks) babies in the current study was 83.6% while preterm (<37 weeks) percentage was 15.4%.
Feeding methods were vastly different: 18 babies were exclusive breast feeding, 9 were formula fed and the remaining cases were mixed feeding.
Complete blood count of all studied cases showed normal findings ,c-reactive protein was negative in all cases . Prolonged indirect hyperbillirubinemia was found in 49 cases (85%) of cases while 8cases (15%) had prolonged direct hyperbillirubinemia.
Many risk factors were found among cases. Breast feeding had the upper hand among all risk factors. Eighteen cases had breast feeding jaundice (32.7%) of cases . ABO incompatibility was found in 12 cases (22%) of cases. Pyuria ≥ six pus cells per high power field was found in 11 cases (20%) of cases. RH incompatibility was found only in 2 cases (3.6%) of cases. Abdominal ultrasonography, done to cases of direct hyperbillirubinemia, showed almost muddy gall bladder for follow up except one case where there was dilated common bile duct for hepato-billiary scintigraphy.