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Cholestatic jaundice in neonates: How common is biliary atresia? Experience at an Australian tertiary centre
Author(s) -
Ling David X H,
Bolisetty Srinivas,
Krishnan Usha
Publication year - 2021
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.15131
Subject(s) - medicine , biliary atresia , cholestasis , neonatal cholestasis , etiology , pediatrics , gestational age , cohort , retrospective cohort study , jaundice , gastroenterology , neonatal intensive care unit , pregnancy , liver transplantation , transplantation , genetics , biology
Aim To (i) review the aetiologies of neonatal cholestasis among term and preterm neonates at a single tertiary centre in Australia; (ii) identify clinical variables associated with biliary atresia (BA) and non‐BA aetiology of neonatal cholestasis; (iii) investigate the utility of hepatobiliary scintigraphy in predicting BA among term and preterm neonates. Methods A retrospective cohort study of neonates born and investigated for cholestasis at two co‐located neonatal and children facilities from January 2013 to December 2017. Results Of the 139 neonates with cholestasis, BA and intestinal‐failure‐associated liver‐disease was the most common cause of neonatal cholestasis in term (18%) and preterm (66%) cohorts, respectively. Incidence of BA was higher in term (1:6) than preterm (1:50) neonates (OR 10.29; 95% CI 2.06–49.97, P = 0.0024). Higher birthweight, acholic stool, absent or abnormal gallbladder on ultrasound was significantly associated with BA while gestational age ≤32 weeks, total parenteral nutrition ≥14 days and low albumin were associated with non‐BA aetiology of cholestasis. In diagnosing BA, non‐draining hepatobiliary scintigraphy demonstrated a lower specificity (73% vs. 90%) and lower positive predictive value (25% vs. 78%) in preterm compared to term neonates. Conclusion Aetiology of cholestasis among preterm neonates differs from those in term neonates and currently existing diagnostic algorithm for neonatal cholestasis may need to be modified for preterm cohort, taking into account the prevalence for each aetiology, potential predictors and cost‐efficiency.