In every neonate presenting with prolonged jaundice persisting beyond day 21 of life, neonatal cholestasis should always be excluded even if the infant is breast fed. Pale stools are an alarm symptom and additional tests for neonatal cholestasis should be carried out directly.
We describe the case of a five-week-old girl of Chilean origin who was referred with conjugated hyperbilirubinaemia. The jaundice had possibly arisen directly after birth, but due to the dark skin colour of the neonate the jaundice was not recognized as such, although her scleras were yellow. According to the stool colour card, her stools were pale. The findings of a histological examination of a liver biopsy confirmed the diagnosis of biliary atresia, for which a Kasai hepatoportoenterostomy was performed.
Neonatal cholestasis is always pathological and requires further investigation. In infants with dark skin, jaundice is sometimes difficult to see and inspection of the scleras should give the definitive answer.
Conflict of interest and financial support: none declared.