Neonatal Cholestasis: A Pandora’s Box

Abstract

Neonatal cholestasis (NC) is a diagnostic dilemma frequently countered in a neonatal care unit. Early diagnosis is vital for achieving an optimal patient outcome as many causes of cholestasis such as biliary atresia are time-sensitive and amenable to treatment if analyzed and treated early. Nonetheless, it is not generally simple to analyze these cases right on time as some of them are regularly missed due to the presence of pigmented stools, lack of newborn metabolic screening, and named as instances of prolonged jaundice. In this manner, we prescribe to explore all reasons for prolonged jaundice stretching out past 14 days in neonates. Besides, we suggest that stool card ought to be a piece of release rundown for all newborn children being released from the nursery. This is of most extreme significance in the nation like India where guaranteeing customary follow-up is as yet a tough assignment. These stool cards will help in the early determination of patients with NC particularly biliary atresia and guarantee their auspicious cure. Another reason which needs exceptional say is parenteral nutrition–associated liver illness, as the proportion of preterm babies is getting greater and greater with better neonatal care. These extreme preterm infants are in the requirement for prolonged (>14 days) total parenteral nourishment because of which they are at high hazard for NC contrasted with their more developed peers. In this survey, we will give an understanding of clinical approach, differential diagnosis, and clinical review of NC.

Biliary atresia combined with progressive familial intrahepatic cholestasis type 3

“…[2,5] It is the most common cause of neonatal cholestasis worldwide. [6–8] PFIC is considered a rare disease, with an estimated incidence of 1/50,000 to 1/100,000 births. All types of PFIC exist worldwide.…”

Cholestasis in Newborns and Infants

“…Step 4: This phase becomes important when BA is overruled; other diagnoses must be sought, such as metabolic conditions [5,[27][28][29][30][31][32][33]; acyl carnitine and aminoacidic profile; urinary succinyl acetone and galactose 1PUDPG will help assessing urea cycle disorders, tyrosinemia and galactosemia among others. The infectious diseases screening is relevant when viral, bacterial, and parasitic liver infections are suspected (CMV, herpes simplex virus type 1 and 2, VHB, VHC, VEB, GBS sepsis, toxoplasmosis, rubella, Chagas disease).…”

Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn

“…With respect to the newborn infant, cholestasis is also associated with an increase in bilirubin production caused by hemolysis, which is caused by lipid profile changes in the circulation leading to rheologic changes in RBC membranes (581). In addition, cholestasis is also associated with the use of hyperalimentation, which is the most common cause in preterm infants, and probably related to inappropriate mixtures and combinations of amino acids in these preparations (16,36,533,641).…”