Neonatal Cholestasis; practical approach

Abstract from Port Said Seventh Neonatology Conference, October 2016

Prof , Tarek Barakat, MD

Ass Professor of Pediatrics/ Gastroentrerology& Hepatologyimg_7132

Faculty of Medicine – Mansoura University

Jaundice is a common clinical finding in the first 1 to 2 weeks after birth and usually resolves spontaneously. Any infant who is jaundiced beyond 2 weeks of life  needs further evaluation to rule out neonatal cholestasis.

Neonatal cholestasis is defined as impaired canalicular biliary flow resulting in accumulation of biliary substances in blood and extrahepatic tissues. These infants should always have fractionated serum bilirubin levels checked to differentiate the conjugated hyperbilirubinemia of cholestasis from unconjugated hyperbilirubinemia that is usually benign.

The differential diagnosis of cholestasis is extensive and a systematic approach is helpful to quickly establish the diagnosis. Biliary atresia is a common cause of neonatal cholestasis and affected infants need surgery before 60 days of life for better prognosis. Premature infants have multifactorial cholestasis and need a modified approach to the evaluation of cholestasis.

Management of cholestasis is mostly supportive, consisting of medical management of complications of chronic cholestasis like pruritus and nutritional support for malabsorption and vitamin deficiency.