RESUMO
The management of neonatal cholestasis continues to be a great task. The present study was designed to evaluate the methods of differentiation between intrahepatic and extrahepatic cholestasis to choose early medical or surgical treatment respectively. This study included 30 newborn infants [18 males and 12 females] with mean age 10.72 +/- 9.59 days. Patients were diagnosed as a cholesteric both clinically and laboratory [conjugated bilirubin more than 30 mmol/L]. Laboratory investigations including hemoglobin level, prothrombin time and concentration, liver enzymes: ALP, GGT, ALT, and AST, blood culture, serology for intrauterine infection [toxoplasma, rubella, cytomegalovirus, hepatitis B and C] and alpha1antitrypsin serum levels were obtained. Abdominal sonography, radionuclide hepatobiliary scintigraphy [Tc-99m-HIDA], and percutaneous needle biopsy were done. Thirty percent of cholesteric patients had Idiopathic neonatal hepatitis [INH]; extrahepatic biliary atresia [EHBA] was detected in 33%, and other causes such as metabolic disorders, septicemia, and congenital infection were detected in 37% of cases. The results of liver biopsy were in line with scintigraphy in 81.8% in cases with extrahepatic obstruction. Patients with higher conjugated bilirubin level showed significantly higher levels of ALP, prothrombin time, higher prevalence of completely obstructed biliary passages and lower prevalence of patent and /or partially obstructed biliary passages defected by scintigraphy, as well as higher prevalence of extrahepatic obstruction detected by liver biopsy. In 100% of the patients, conjugated bilirubin carried very good relationship with scintigraphy in cases with complete biliary passages obstruction. Cases with relatively higher ALP level showed significantly higher prevalence of EHBA and in 85% of the patients, ALP carried very good relationship with scintigraphy denoting extrahepatic obstruction. A significant positive correlation was detected between GGT and ALP [r = 0.512 p<0.01] and a significant negative correlation was detected between prothrombin concentration and GGT, AST, and ALT [r = - 0.359 p<0.05; r = - 0.415 p<0.04; r= - 0.358, p<0.05 respectively]. The prevalence of complete biliary passage obstruction detected by scintigraphy was significantly higher in cases with relatively higher GGT [>100 IU/L] and the prevalence of patent and /or partially obstructed biliary passages detected by scintigraphy was significantly Iower than the rest of cases [p<0.03 for each]. The prevalence of extrahepatic obstruction detected by liver biopsy did not differ significantly between the two groups. Cases with INH showed a significantly higher prevalence of patent and /or partially obstructed biliary passages detected by scintigraphy, as well as significantly Iower prevalence of extrahepatic obstruction detected by liver biopsy. Scintigraphy and liver biopsy carried very good relationship with INH in 77.5% and 88.8% of cases respectively
Conclusion: Tc-99 m-HIDA may be a better method of assessing extrahepatic biliary passages obstruction than liver biopsy, as it is less invasive method and could rapidly differentiate between intrahepatic and extrahepatic cholestasis, so this can help in choosing the early medical or surgical treatment