Varied Aetiologies and Outcome of Neonatal Cholestasis: A Series of Four Cases

Abstract

Neonatal cholestasis is a significant cause of chronic liver disease in infants. However, lack of awareness among parents and primary care physicians often leads to delayed diagnosis and management of these children. In this series, the authors discussed four cases of neonatal cholestasis (48 days term female, 3 months term male, 73 days old female, 33 days old term male) that presented in the outpatient department with the chief complaint of yellowish discolouration of the eyes and pale-coloured stools. Clinical and histochemical findings in all cases were suggestive of neonatal cholestasis. The neonates were treated with Ursodeoxycholic Acid (UDCA), vitamin ADEK, and followed up. Fortunately, in all the babies, symptoms resolved after management, except for a three-month-old male baby who unfortunately succumbed to liver failure after two weeks of hospitalisation. Early identification of Progressive Familial Intrahepatic Cholestasis (PFIC) disorders is crucial as it enables effective management and potential definitive therapy. Additionally, prompt implementation of a galactose-free diet is critical for preventing acute toxicity and minimising tissue damage in galactosemia. Late presentation of biliary atresia can lead to increased morbidity and mortality. Therefore, it is crucial to include stool and urine charts in the discharge summary of every newborn and provide parental education on recognizing the signs of cholestasis in the Paediatric Outpatient department.

Keywords

• biliary atresia
• hyperbilirubinemia
• progressive familial intrahepatic cholestasis
• kasai procedure