Clinico-radiologic, laboratory, and histopathologic profile of patients diagnosed with neonatal cholestasis at Philippine Children's Medical Center

ABSTRACT

@#<p style="text-align justify;"><strong>BACKGROUND:</strong> Neonatal Cholestasiswarrants early, accurate and prompt intervention and comprises a wide spectrum of differential diagnosis which present with overlapping features, thus making a diagnosis difficult.</p><p style="text-align justify;"><strong>OBJECTIVE:</strong> To evaluate the clinical and laboratory parameters that could aid to differentiate between intrahepatic and extrahepatic neonatal cholestasis.</p><p style="text-align justify;"><strong>METHODS</strong> Retrospective and Descriptive study of Neonatal Cholestasis patients who underwent Liver Biopsy and admitted at the Philippine Children's Medical Center from January 2007 to December 2011.</p><p style="text-align justify;"><strong>RESULTS:</strong> Factors that favor an intrahepatic cause of Cholestasis are ultrasound finding of a normal gallbladder, marked degree of giant cell transformation and presence of extramedullary hematopoiesis. Factors that favor an Extrahepatic cause of Cholestasis are presence of Splenomegaly, markedly elevated GGT, and histopathology findings of Portal and Periportal Ductal proliferation, bile plugs, lesser degree of giant cell transformation, septal fibrosis and cirrhosis, portal and neoductular cholestasis, and Portal-Portal bridges.</p><p style="text-align justify;"><strong>CONCLUSION:</strong> In this study, meticulous history and physical examination aid in the diagnosis of Neonatal Cholestasis. Splenomegaly and markedly elevated serum GGT are suggestive of Biliary Atresia, and a normal Gallbladder by Ultrasound favors Neonatal Hepatitis. Although there is significant overlap of histopathologic findings of patients with neonatal cholestasis, certain parameters favor an extrahepatic over an intrahepatic process.</p>