Clinic-o-etiological profile of cholestasis in infants in a tertiary care center

Abstract

Common presenting feature of hepatobiliary and metabolic dysfunction in neonates is cholestatic jaundice. It is essential to recognise the neonatal cholestasis early. Significant proportion of cases of cholestatic disease are constituted by EHBA. If management of Extra Hepatic Biliary Atresia is delayed beyond three months of life, only option available then is liver transplantation.To analyse etiological factors and to study clinical presentation of cases presenting with cholestasis.Study the clinical presentation and analyse the etiological factors in infants with cholestasis. To determine the validity of ACS and compare outcomes of EHBA with respect to age at presentation.Prospective observational study was done in 104 infants with cholestasis who were admitted in Paediatric ward of niloufer hospital from January 2019 to July 2020.Statistical analysis done by chi square test and fisher’s exact tests.Of the total 104 cases, 47 cases were diagnosed to be EHBA and 38 cases were found to have neonatal hepatitis.58.6% were male and 41.34%were female and 72 were term and 32 were preterm. Mean age of presentation with EHBA and Neonatal hepatitis was 91 days and 94 days. LFT’s in EHBA cases showed mean TSB 12.19 ± 5 mg/dl Vs 11.7 ± 5.8 mg/dl in NH babies with a p value equal to 0.379. Direct bilirubin revealed 6.44 ± 3.1mg/dl Vs 6.64 ± 3.1mg/dl in NH group (p = 0.824).HIDA scan showed 41% had EHBA, 33.3% had NH AIIMS Clinical score (ACS) cannot correctly differentiate EHBA from NH.Survival was significantly higher in infants with EHBA who were operated before 60 days of life.