Journal of pediatric gastroenterology and nutrition · 2025
Less is more: 15-year audit of the evaluation of cholestatic jaundice in the neonatal intensive care unit.
СтатьяНазвание и аннотация: Перевод в очереди
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Moin Zeba S, Roberts Amin J, Buksh Mariam J, Knight David B, Evans Helen M
Аннотация
OBJECTIVE: Neonatal cholestatic jaundice (cholestasis) has extensive aetiologies and occurs frequently in preterm infants in neonatal intensive care units (NICUs). Current multinational guidelines involve wide-ranging investigations suited to general newborn populations without validation in NICU settings. We retrospectively reviewed New Zealand's guidelines for investigating cholestatic jaundice in the NICU.
METHODS: Infants admitted to one tertiary NICU between 2008 and 2022 with direct bilirubin ≥20 µmol/L and percentage of total bilirubin ≥20% were identified from laboratory records. Investigations, health data and outcome data were obtained from clinical records.
RESULTS: Cholestasis was detected in 208 (1.5% admissions) with median gestational age of 27 weeks and birth weight of 942 g. Eight (3.8%) had primary liver diseases, all presenting in the early newborn period. Four (1.9%) with biliary atresia manifested cholestasis and acholic stool within 1-month postnatal age; two were born preterm and survived >5 years transplant-free post-portoenterostomy. There were no delayed or missed diagnoses of primary liver disease. The remaining 200 (96.2%) had hepatobiliary dysfunction related to preterm comorbidities, intestinal failure-associated liver disease, cytomegalovirus infection, rare extrahepatic congenital disease or unknown causes. Investigations included liver biopsy in 28 (13.5%), hepatobiliary scintigraphy in 7 (3.4%), intraoperative cholangiography in 4 (1.9%) and 1 (0.5%) percutaneous cholangiogram. Overall, invasive testing for rare congenital diseases was done infrequently.
CONCLUSIONS: Most NICU infants with cholestasis did not have congenital diseases, and the small minority who did were all distinguishable by clinical factors regardless of gestation.
METHODS: Infants admitted to one tertiary NICU between 2008 and 2022 with direct bilirubin ≥20 µmol/L and percentage of total bilirubin ≥20% were identified from laboratory records. Investigations, health data and outcome data were obtained from clinical records.
RESULTS: Cholestasis was detected in 208 (1.5% admissions) with median gestational age of 27 weeks and birth weight of 942 g. Eight (3.8%) had primary liver diseases, all presenting in the early newborn period. Four (1.9%) with biliary atresia manifested cholestasis and acholic stool within 1-month postnatal age; two were born preterm and survived >5 years transplant-free post-portoenterostomy. There were no delayed or missed diagnoses of primary liver disease. The remaining 200 (96.2%) had hepatobiliary dysfunction related to preterm comorbidities, intestinal failure-associated liver disease, cytomegalovirus infection, rare extrahepatic congenital disease or unknown causes. Investigations included liver biopsy in 28 (13.5%), hepatobiliary scintigraphy in 7 (3.4%), intraoperative cholangiography in 4 (1.9%) and 1 (0.5%) percutaneous cholangiogram. Overall, invasive testing for rare congenital diseases was done infrequently.
CONCLUSIONS: Most NICU infants with cholestasis did not have congenital diseases, and the small minority who did were all distinguishable by clinical factors regardless of gestation.