Study on Etiological Shunting of Neonatal Cholestasis by High-Frequency Ultrasound Combined with Clinical Indicators

Abstract

Purpose Retrospectively evaluating the biliary atresia (BA) - related ultrasound (US) and clinical indictors and exploring the feasibility of surgical shunting for neonatal cholestasis (NC) with a simplified two-step strategy: clinical indicators and US evaluation. Methods A total of 152 infants were enrolled and divided into BA group (80 cases) and non-BA group (72 cases). Their detailed US signs, clinical features and laboratory tests were collected, and their diagnostic performances were compared. Results Among physical and routine laboratory indicators: pale stool, hepatomegaly, γ-glutamyl transferase > 117 U/L, direct bilirubin > 87.7 μmol/L, total bilirubin > 131.9 μmol/L appeared significantly different between the two groups. They could act as the early warning indicators for detailed US evaluation. The combination of the following five US signs had better diagnostic efficiency with highest sensitivity (100%): “anterior-wall thickness of the right portal vein >1.6 mm”, “triangular cord sign”, “portal vein diameter > 5.1 mm”, “hepatic subcapsular flow” or “porta hepatic cystic or tubular echoes”. They might act as US shunting signs for surgical exploration. Among the signs of abnormal gallbladder, “irregular gallbladder wall” showed higher efficiency (AUC 0.733), which followed by fasting gallbladder length ≤ 1.8 cm and non-visualization of gallbladder. Moreover, a new laboratory indicator - the matrix metallopeptidase-7 (MMP-7)had an excellent diagnostic value (AUC 0.989) with a cut-off value of 14.04 ng/ml. Conclusions When the early clinical warning indicators appears in NC children, the intensive US evaluation may be helpful in the etiology shunting. And widely use of MMP-7 is promising.