Neonatal Cholestasis- when to suspect

Neonatal cholestasis is defined as jaundice with high color urine staining diaper in an infant within first 3 months of life. 

The common  causes of neonatal cholestasis are – 

1) Extra hepatic – biliary atresia, choledocal cyst 

2) Intrahepatic – Idiopathic Neonatal Hepatitis (INH)

3) Infectious – TORCH infection 

4) Metabolic – Galactosemia, Tyrosinemia, etc. 

It should be kept in mind that Idiopathic Neonatal Hepatitis (INH) which is the most common cause of neonatal cholestasis is a diagnosis of exclusion. Its diagnosis can be confirmed only  by excluding other causes of cholestasis  and  these children improve completely on follow up.

When to suspect Neonatal Cholestasis

Any new born with jaundice and dark yellow urine staining the diaper with or without pale stools should be strongly suspected to have Neonatal Cholestasis.

Biliary Atresia usually  presents with  jaundice with diaper staining in an otherwise healthy well thriving baby.

Metabolic disorders commonly present with cholestasis with decompensation like bleeding, ascites and coagulopathy like galactosemia, tyrosinemia and neonatal hemochromatosis.

A detailed history and clinical examination helps to narrow down the differential diagnosis and focus investigation to confirm the diagnosis

Every infant with cholestasis needs early referral to Pediatric Gastroenterologist for evaluation of under laying cause without delay. 

Next post: Investigations in Neonatal Cholestasis

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