Neonatal Cholestasis; practical approach
Abstract from Port Said Seventh Neonatology Conference, October 2016
Prof , Tarek Barakat, MD
Ass Professor of Pediatrics/ Gastroentrerology& Hepatology
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.