Routine use of HIDA scan should be discouraged in all cases of neonatal cholestasis. Infant with neonatal cholestasis with pale stool (abnormal stool) where possibility of biliary atresia is high, time should not be wasted for a HIDA scan.
In case of normally pigmented stool, there is no role of HIDA scan.
However, HIDA scan can be considered in the following situations in neonatal cholestasis-
- Infant with neonatal cholestasis with changing stool color (earlier pale stools and now pigmented stool)
- Neonatal cholestasis with ambiguous stool (stools which are not clearly pale or pigmented)
In above scenarios, an Excretory HIDA scan report rules out biliary atresia, as it has very high negative predictive value (100%) for ruling out biliary atresia.
However, a non-excretory HIDA scan can be found in both biliary atresia and non-biliary atresia cases, as its positive predictive is only 56%.
Priming with phenobarbitone prior to HIDA is not recommended.
Priming with UDCA is preferable and is given for 3 to 5 days prior to HIDA scan is required.