Prolonged neonatal cholestasis; think of biliary atresia first

Original article


Rabia Gwedar1, Khaled A Youseif1, Bashir Elgarmoul2 and Fauzi Sagher1

1) Department of Paediatric Gastroenterology, Hepatology & Nutrition, TMC. Faculty of Medicine Elfateh University; 2) Department of Paediatric Surgery, TMC, Tripoli, Libya

JMJ Vol.4 No. 3 (Winter) 2005: 186-191


In the newborn, jaundice for more than 14 days is pathological and requires investigations. A raised serum bilirubin with conjugated component of more than 20% of total, positive urinary bile pigment and pale stool are always pathological even if the total bilirubin is as low as 5mg/dl. It is usually occurs as a part of neonatal hepatitis syndrome. Our aims were to identify infants with biliary atresia, to confirm the diagnosis and provide corrective surgery as early as possible, and to find quick diagnostic approach for the infants with cholestatic jaundice. A total of 58 infants with cholestatic jaundice referred to the department of gastroenterology and hepatology during 44 months since Feb 1999, for evaluation of prolonged jaundice, undergo biochemical, ultrasound, radiological and histological evaluation. Eighteen infants were with extrahepatic pathology (31%), of which fourteen were extrahepatic biliary atresia (78% of total extrahepatic pathology). The majority presented late, mean age at presentation was 99.9 days. Only two infants out of 58 were with choledocal cyst (11% of total extrahepatic pathology). 63.6% of proven extrahepatic biliary atresia died at mean age of 13.7 months. In conclusion; quick referral, prompt investigations and early intervention are essential to improve the outcome

Keywords: Neonatal Cholestasis, Biliary atresia, Liver biopsy, Ultrasound, Duodenal aspirate, Operative cholangiography