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#Gastroenterology #Hepatology #Multispeciality
Biliary atresia (BA) is characterized as an obstructive cholangiopathy involving both the intrahepatic and extrahepatic bile ducts. It presents as persistent jaundice, clay-colored stools, and hepatomegaly in neonates. Usually the etiology of BA is unknown.
The current study evaluated the etiologies of neonatal cholestasis among term and preterm neonates at a single tertiary center. Investigators also assessed clinical variables associated with both BA and non-BA etiology of neonatal cholestasis. In addition, beneficial effects of hepatobiliary scintigraphy in identifying BA among term and preterm neonates were also analyzed. For these purposes, neonates with cholestasis were studied at two co-located neonatal and children facilities from January 2013 to December 2017.
The outcome of the study revealed that among neonates with cholestasis, BA was the most frequent cause of neonatal cholestasis in term (18%) neonates while intestinal-failure-associated liver-disease was the most common etiology in preterm (66%) neonates. Moreover, incidence of BA was higher in term (1:6) than preterm (1:50) neonates. Neonates with BA reported higher birthweight, acholic stool, absent or abnormal gallbladder on ultrasound whereas non-BA etiology of cholestasis was remarkably associated with gestational age ≤32 weeks, total parenteral nutrition ≥14 days and low albumin. Additionally, non-draining hepatobiliary scintigraphy used for the diagnosis of BA demonstrated a lower specificity (73% versus 90%) and lower positive predictive value (25% versus 78%) in preterm in contrast to term neonates.
The study concluded that etiology of cholestasis is different among preterm and term neonates. Therefore, it warrants the need to modify the current algorithm for diagnosis of cholestasis in preterm neonates, in consideration with the prevalence for each etiology, potential predictors and cost-efficiency.
Source: Ling DXH, Bolisetty S, Krishnan U. Cholestatic jaundice in neonates: How common is biliary atresia? Experience at an Australian tertiary centre [published online ahead of print, 2020 Aug 17]. J Paediatr Child Health. 2020;10.1111/jpc.15131.