Infantile Cholestasis: Approach and Diagnostic Algorithm

Abstract

Cholestasis is a central key manifestation of hepatobiliary disease in all age groups. The neonatal liver is more susceptible to cholestasis as compared to older children and adults. The incidence of cholestasis in neonates is 1 in 2500–5000 live births, with the most commonly identified etiology biliary atresia. Every infant presenting with jaundice beyond 2 weeks of age (3 weeks if the infant is breast-fed and has otherwise normal physical examination and history) should be evaluated with a fractionated bilirubin level as clearly stated in the guidelines published by North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) in 2004. Prompt evaluation and diagnosis is important since early intervention and management leads to improved clinical outcome. This chapter outlines the epidemiology, etiology, and diagnostic evaluation for cholestatic jaundice in infants.