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What Causes Neonatal Cholestasis?

Posted on Mon, 12 May 2014

Question: My son was diagnosed with neonatal cholestasis. He is 3 months old. He was diagnosed with this at 1 1/2 months. The doctors are not sure why he has this. He was hospitalized for 5 days and the only diagnosis they could definitely say was he had rhinovirus. He has been through an ultrasound, a hida scan, and blood work. They are discussing a possible liver biopsy. They gave him vitamins and ever since the vitamins his liver function levels have worsened. I am not sure where to turn. We are suppose to have one of the top Children's Hospitals in the country. The liver specialist came straight out and told me that they may never know. She said it could be a hundred and one different things. Any input would be helpful.

Answered by Dr. Deepak Kishore Kaltari (32 minutes later)

Brief Answer: Possibility of Biliry atresia to be considered Detailed Answer: Hi Welcome to Healthcare-Magi Greetings of the day Being a Pediatric Surgeon, I encounter several such cases. Progressive Jaundice especially if its predominantly Conjugated(Direct) Hyper-bilirubinemia possibility of Biliary Atresia needs to be considered. Biliary atresia is non development of bile duct leading to progressive jaundice and deteriorating Liver function. It would be very helpful if you could revert back to me with the following additional information 1. Was your son born at full term? 2. Any NICU admission or neonatal resuscitation? 3. When did the jaundice first occur 4. What is colour of stools 5. Detailed laboratory investigation done till date(it would be more helpful if you could also specify the date of birth, date of investigation done and values), images of HIDA scan and ultrasound including the report Do not worry will definitely find a way out. Waiting for your reply Best Regards Dr Deepak Kishore MBBS,MS,MCH Consultant Pediatric Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (32 minutes later)

My son was born at 39 weeks. His birthdate is January 13, 2014. There was no NICU or neonatal resuscitation. His APGAR score was a 9 out of 10. He was 5.7lbs and 18 inches long. The jaundice appeared on February 27. I had scheduled an appointment with a new pediatrician because he had a cold. (He saw another pediatrician a week prior for his 1 month checkup and he was fine.) That is when we noticed the jaundice. they admitted him for 5 days. This is some of the blood work from Feb. 27 Alk Phos Date:Feb. 27, 2014 9:20 p.m. EST Result:799 Int'l Unit/Liter (High) Normal: < 360 Int'l Unit/Liter AST/SGOT Date:Feb. 27, 2014 9:20 p.m. EST Result:136 Int'l Unit/Liter (High) Normal: 22 Int'l Unit/Liter - 63 Int'l Unit/Liter ALT/SGPT Date:Feb. 27, 2014 9:20 p.m. EST Result:185 Int'l Unit/Liter (High) Normal: 17 Int'l Unit/Liter - 63 Int'l Unit/Liter Bili, Direct Date:Feb. 27, 2014 9:20 p.m. EST Result:6.7 Milligrams/deciliter (High) Normal: 0.1 Milligrams/deciliter - 0.5 Milligrams/deciliter Bili, Unconjugated Date:Feb. 27, 2014 9:20 p.m. EST Result:3.5 Milligrams/deciliter Bili, Total Date:Feb. 27, 2014 9:20 p.m. EST Result:10.2 Milligrams/deciliter (High) Normal: 0.2 Milligrams/deciliter - 1.3 Milligrams/deciliter Total Protein Date:Feb. 27, 2014 9:20 p.m. EST Result:6.7 grams/deciliter Normal: 5.1 grams/deciliter - 7.3 grams/deciliter Albumin Date:Feb. 27, 2014 9:20 p.m. EST Result:3.6 grams/deciliter (Low) Normal: 3.8 grams/deciliter - 5.4 grams/deciliter This is some of the latest blood work. gGTP Date:March 26, 2014 10:10 a.m. EDT Result:851 Int'l Unit/Liter (High) Normal: < 121 Int'l Unit/Liter Alk Phos Date:March 26, 2014 10:10 a.m. EDT Result:924 Int'l Unit/Liter (High) Normal: < 360 Int'l Unit/Liter AST/SGOT Date:March 26, 2014 10:10 a.m. EDT Result:131 Int'l Unit/Liter (High) Normal: 22 Int'l Unit/Liter - 63 Int'l Unit/Liter ALT/SGPT Date:March 26, 2014 10:10 a.m. EDT Result:202 Int'l Unit/Liter (High) Normal: 17 Int'l Unit/Liter - 63 Int'l Unit/Liter Bili, Direct Date:March 26, 2014 10:10 a.m. EDT Result:3.8 Milligrams/deciliter (High) Normal: 0.1 Milligrams/deciliter - 0.5 Milligrams/deciliter Bili, Total Date:March 26, 2014 10:10 a.m. EDT Result:6.4 Milligrams/deciliter (High) Normal: 0.2 Milligrams/deciliter - 1.3 Milligrams/deciliter Total Protein Date:March 26, 2014 10:10 a.m. EDT Result:6.7 grams/deciliter Normal: 5.1 grams/deciliter - 7.3 grams/deciliter Albumin Date:March 26, 2014 10:10 a.m. EDT Result:3.8 grams/deciliter Normal: 3.8 grams/deciliter - 5.4 grams/deciliter Vitamin 25OH D2 Date:March 12, 2014 10:10 a.m. EDT Result:< <4 Nanograms/Milliliter Vitamin 25OH D3 Date:March 12, 2014 10:10 a.m. EDT Result:7 Nanograms/Milliliter Vitamin 25OH Total Date:March 12, 2014 10:10 a.m. EDT Result:7 Nanograms/Milliliter (Low) Normal: 25 Nanograms/Milliliter - 100 Nanograms/Milliliter The Dr. said they don't think it's biliary atresia. When they ran the test on Monday it looked like it was. They discussed surgery then ran the HIDA scan in 24 hours and we were released because it looked good. The radiologist saw the bile was flowing but was taking a while. She mentioned a malabsorption syndrome. She said there are a ton of them. I can upload the rest of the test results when I get home from work if you need. They did a sweat test which came back negative for CF. They also sent out blood work for genetic testing and we are waiting on the results of that.

Answered by Dr. Deepak Kishore Kaltari (8 hours later)

Brief Answer: To rule out atresia and bile plug syndrome Detailed Answer: Hi Greetings Thanks for the reply. Based on the reports it is predominantly elevated conjugated Hyper bilirubin. Associated elevated alkaline phosphate and Gamma glutamyl transferase suggest the possibility of obstructive jaundice. Biliary plug or Biliary atresia needs to be ruled out. I would like to see the HIDA scan images . Was the test done after giving Phenobarbitone? Was it given anytime ? Kindly get back to me with Ultrasound and HIDA reports and images. Take care Best Regards Dr Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (8 hours later)

They gave him Phenobarbital for 3 days prior to the test. I am still waiting on the image results and reports. The hospital told me that it can take up to a month to get them.

Answered by Dr. Deepak Kishore Kaltari (3 hours later)

Brief Answer: MRCP required Detailed Answer: Hi Greetings In my clinical practice if the diagnosis of Obstructive jaundice is not very obvious , either it does not fit into Biliary atresia, Ultrasound is not conclusive,HIDA is not informative. I follow two options 1. Magnetic resonance Cholangiopancreatography(MRCP) 2. Laparoscopic Biliary Chongiogram I would suggest you to discuss it with your treating Physician. Also discuss the probability of bile plug syndrome. Take Care Best Regards Deepak

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar