Neonatal Kolestazlı İnfantların Değerlendirilmesi: Türkiye'den Bir Üçüncü Basamak Referans Merkezinin Deneyimi

Abstract

ABS TRACT Objective: Neonatal cholestasis can be the initial evidence of a heterogeneous group of diseases of different etiologies. The aim of the study is to evaluate the patients with neonatal cholestasis and analyse the etiologic factors, diagnostic tools and outcome. Material and Methods: Seventy-five patients (65% males, 45% females) between 0-6 months of age with neonatal cholestasis were retrospectively evaluated; analysed for the clinical, laboratory, radiological, scintigraphic data and histopathological findings from liver biopsies. Results: Eighty per cent of the infants’ admitted to our hospital because of prolonged jaundice. The onset of the jaundice was in the first week of life in 64% of the cases, but admission time of the referral center was median two months. Biliary atresia (BA) was determined in 21 (28%), neonatal hepatitis (NH) in 54 (72%) of the patients. Biliary atresia group had significantly more frequent acholic stool, relatively lower aspartate aminotransferase, but higher gamma-glutamyl transpeptidase, and serum protein levels. Liver biopsy and hepatobiliary scintigraphy were the most sensitive methods for differentiation BA from NH (p<0.05). During the follow-up period, 13 of the patients (18%) died, whereas cholestasis improved in 14 of the patients with NH (27%) within median 6 months. Survival rate at one year was 45.5% for the patients with BA, and 87% for the patients with NH. So patients with NH had better prognosis (p<0.05). Conclusion: It has been evident that early diagnosis and intervention of treatable causes of neonatal cholestasis have a vital importance.