Q. How do you approach a case of neonatal cholestasis?
A. Newborn babies having jaundice beyond 14 days of age with dark urine with/without acholic stools should be referred immediately to an appropriate center for further investigations and treated without any loss of time.

Unfortunately, it is not possible to differentiate between various disorders causing hyperbilirubinemia by simple liver biochemistry. It has been shown that results of such cases are much better in centers handling a large volume of these cases and where most facilities to carry out the required tests are available, thereby enabling standardization and evolution of optimum investigative and management protocols and surgical techniques.

Our recent experience of these cases is given in Table 2 and our current investigation protocol is outlined in Table 3 and Table 4.

Jaundice, dark urine with/without acholic stools at 14 days of life.

Increased Urine bilirubin + serum bilirubin (conjugated)

LFT, administer vitamins and Vitamin K 5mg IM

Refer to a specialized centre

Clinical Examination/Biochemical/Routine tests/Special Etiological Tests/ USG/Radiological tests/Funduscopy and HBS

HBS -Hepatobiliary scan, LFT - Liver function tests, NNH - Neonatal hepatitis, BA - Biliary atresia