Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country

Poddar, Ujjal; Thapa, Babu Ram; Das, Ashim; Bhattacharya, Anish; Rao, KL Narasimha; Singh, Kartar

doi:10.1111/j.1651-2227.2009.01338.x

Cited by 49 publications

(54 citation statements)

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“…Hessel et al (15) reported that the sensitivity was 76% for liver biopsy in diagnosing extrahepatic cholestasis, with an accuracy of 86% for biopsy, rising to 96% when both tests (liver biopsy and ultrasound) were considered together. Poddar et al (22) reported that the liver biopsy was 100% accurate in differentiating BA from neonatal hepatitis. …”

Section: Discussionmentioning

confidence: 99%

Predictive value of hepatic ultrasound, liver biopsy, and duodenal tube test in the diagnosis of extrahepatic biliary atresia in Serbian infants

Boskovic

Kitic²,

Prokić³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Extrahepatic biliary atresia (EHBA) is the most important cause of neonatal cholestasis. The validity of different diagnostic methods in the diagnosis of EHBA in developed countries has been presented elsewhere, but data from developing countries with low national incomes are scarce. The aim of this study was to investigate the relative accuracy and roles of abdominal ultrasonography, duodenal tube test (DTT), and liver biopsy in the diagnosis of EHBA in Serbia. Materials and Methods: The study included 156 infants with cholestasis admitted at the Mother and Child Health Care Institute. Data were collected according to the medical records observation technique. Results: Extrahepatic biliary atresia was diagnosed in 72 of 156 infants with cholestasis. The frequency was insignificantly higher in females than in males (1.25:1). Most patients were diagnosed prior to 60 days of life (median 58, range 30-67). In a group of 156 infants with cholestasis, 109 had ultrasound, liver biopsy, duodenal tube test, and intraoperative cholangiography done. Liver biopsy confirmed surgical disease in 71/109 patients and denied it in 38/109 patients (sensitivity-Sn 98%, specificity-Sp 100%, diagnostic efficiency of test-DgEf 99.08%). Duodenal tube test had Sn 97%, Sp 72%, and DgEf 88.99%, and the ultrasound findings showed Sn 78%, Sp 81%, and DgEf 77.92%. Five-year survival rate after Kasai operation was 76%. Conclusion: A well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia. Histology examination of biopsy specimens is an integral part of the diagnostic algorithm and, therefore, plays a pivotal role in the diagnostic evaluation of this disease.

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Section: Discussionmentioning

confidence: 99%

Predictive value of hepatic ultrasound, liver biopsy, and duodenal tube test in the diagnosis of extrahepatic biliary atresia in Serbian infants

Boskovic

Kitic²,

Prokić³

et al. 2014

Turk J Gastroenterol

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“…PFIC accounts for 3-13% cases of neonatal cholestasis syndrome (NCS) and accounts for 10-15% of children requiring liver transplantation (LT). [3][4][5][6][7] It has an estimated prevalence of 1 per 50,000 to 1 per 100,000 births although the exact prevalence is unknown. 1,8 PFIC 1 and 2 present in infancy or early childhood, whereas PFIC 3 can present at any age from infancy to adolescence.…”

Section: P Rogressive Familial Intrahepatic Cholestasis (Pfic) Ismentioning

confidence: 99%

Progressive Familial Intrahepatic Cholestasis (PFIC) in Indian Children: Clinical Spectrum and Outcome

Agarwal

Lal

Rawat

et al. 2016

Journal of Clinical and Experimental Hepatology

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“…3,13,14 La instalación de la ictericia en las primeras dos semanas, la persistencia de materias hipocólicas, los valores de BT mayores de 12 mg/dLy de BD mayores de 6,8 mg/dL presentaron buena sensibilidad para el diagnóstico de atresia biliar, pero baja especificidad (50% a 60%). 13 La hipocolia fue el signo con mayor sensibilidad (86%) y especificidad (76%). 13,14 El ser pequeño para la edad gestacional presentó mayor asociación con la hepatitis neonatal.…”

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“…13 La hipocolia fue el signo con mayor sensibilidad (86%) y especificidad (76%). 13,14 El ser pequeño para la edad gestacional presentó mayor asociación con la hepatitis neonatal. 13,14 La ecografía abdominal tiene baja sensibilidad, por lo que no permite descartar el diagnóstico de atresia biliar cuando su resultado es normal.…”

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Colestasis neonatal por toxoplasmosis congénita. A propósito de un caso clínico

2013

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Arch Argent Pediatr 2013;111(4):e105-e108 / e105Presentación de casos clínicos RESUMEN La colestasis neonatal es la forma de presentación de diversas enfermedades; es necesario un diagnóstico etiológico temprano, ya que el tratamiento antes de los 60 días de vida cambia el pronóstico en los niños que presentan atresia biliar. La toxoplasmosis congénita puede ser asintomática en el recién nacido, o presentar fundamentalmente alteraciones neuroló-gicas, oftalmológicas y hepáticas (hepatomegalia, ictericia no colestásica). La colestasis neonatal secundaria a toxoplasmosis congénita no es una situación informada con frecuencia. Se presenta el caso de un lactante con colestasis neonatal cuya etiología responde a una toxoplasmosis congénita, con el objetivo de discutir las dificultades en establecer el diagnóstico etiológico y las indicaciones de realizar estudios invasivos, como la biopsia hepática, en estas situaciones. Palabras clave: colestasis neonatal, toxoplasmosis, ictericia neonatal, atresia biliar. SUMMARYNeonatal cholestasis is the manifestation of many different diseases. Its early etiological diagnosis is crucial, since treatment before 60 days of life changes the prognosis in children with biliary atresia. Congenital toxoplasmosis can be asymptomatic in the newborn, or have mainly neurological, ophthalmological or gastrointestinal symptoms (hepatomegaly, cholestatic jaundice). Neonatal cholestasis secondary to congenital toxoplasmosis is not a situation frequently reported. We report the case of an infant with neonatal cholestasis due to a congenital toxoplasmosis, in order to discuss the difficulties in establishing the etiological diagnostic and to review the indications of invasive studies such as liver biopsy in these situations.

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Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country

Abstract: One-third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA.

Cited by 49 publications

References 13 publications

Predictive value of hepatic ultrasound, liver biopsy, and duodenal tube test in the diagnosis of extrahepatic biliary atresia in Serbian infants

Predictive value of hepatic ultrasound, liver biopsy, and duodenal tube test in the diagnosis of extrahepatic biliary atresia in Serbian infants

Progressive Familial Intrahepatic Cholestasis (PFIC) in Indian Children: Clinical Spectrum and Outcome

Colestasis neonatal por toxoplasmosis congénita. A propósito de un caso clínico

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