Italian guidelines for the management and treatment of neonatal cholestasis.

Carlo Dani,Simone Pratesi,Costantino Romagnoli,Francesco Raimondi

doi:10.1186/s13052-015-0178-7

Abstract

Hyperbilirubinemia is a frequent condition affecting newborns during the first two weeks of life and when it lasts more than 14 days it is defined as prolonged jaundice. This condition requires differential diagnosis between the usually benign unconjugated hyperbilirubinemia and the pathological conjugated hyperbilirubinemia, that is mainly due to neonatal cholestasis. It is important that the diagnosis of neonatal cholestasis be well-timed to optimize its management, prevent worsening of the patient’s outcome, and to avoid premature, painful, expensive, and useless tests. Unfortunately, this does not always occur and, therefore, the Task Force on Hyperbilirubinemia of the Italian Society of Neonatology presents these shared Italian guidelines for the management and treatment of neonatal cholestasis whose overall aim is to provide a useful tool for its assessment for neonatologists and family pediatricians.

Highlights

Hyperbilirubinemia is a very common condition that can occur in 2.4 to 15 % of newborns during the first two weeks of life [1]
Prolonged jaundice is defined as jaundice lasting more than 14 days or recurring after the second week of life [2, 3]
– Infants with cholestasis must be given a caloric intake of approximately 125 % more than the recommended dietary intake for healthy infants with a preference for Medium chain triglycerides (MCT) as a lipid source

Summary

Introduction

Hyperbilirubinemia is a very common condition that can occur in 2.4 to 15 % of newborns during the first two weeks of life [1]. Prolonged jaundice is defined as jaundice lasting more than 14 days or recurring after the second week of life [2, 3]. This condition requires careful evaluation to differentiate unconjugated hyperbilirubinemia, that is usually benign [4], from infrequent conjugated hyperbilirubinemia, that is always pathological [3], and is mainly due to neonatal cholestasis [3,4,5]. Many pathologies can cause neonatal cholestasis and require medical or surgical treatment. Even when specific treatment is not available or curative, infants who have cholestasis may benefit from early medical management and optimization of nutrition to prevent complications. It is important that the diagnosis of neonatal cholestasis be well-timed, both to prevent the worsening of the patient’s outcome due to a delayed diagnosis [6], and to avoid carrying

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