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Isolation of Neonatal Extrahepatic Cholangiocytes
Published on: June 5, 2014
Pre-admission consultation and late referral in infants with neonatal cholestasis
1Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia. leews@um.edu.my
Insights
Delayed referral in neonatal cholestasis, often due to false reassurance or service failures, impacts outcomes for conditions like biliary atresia (BA). Early detection through screening is crucial for improving infant survival rates.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Neonatal Medicine
Background:
- Neonatal cholestasis presents diagnostic challenges, potentially leading to delayed interventions.
- Timely referral is critical for managing conditions such as biliary atresia (BA) and neonatal acute liver failure (NALF).
Purpose of the Study:
- To investigate factors contributing to delayed referrals in infants with neonatal cholestasis at a Malaysian tertiary care center.
- To identify specific barriers hindering timely diagnosis and management.
Main Methods:
- Prospective, observational study design.
- Inclusion of consecutive infants diagnosed with neonatal cholestasis referred to a specialized pediatric liver unit.
- Data collection on referral timelines, reasons for delay, and patient outcomes.
Main Results:
- 43% of 65 infants experienced delayed or inappropriate referrals.
- Key factors included medical/paramedical reassurance (26%), referring hospital service failures (11%), and parental refusal (8%).
- Liver transplantation (LT) was performed in only 14% of patients with liver failure; 1-year survival for BA was 35% (native liver) and 41% (overall).
Conclusions:
- False reassurance, healthcare system deficiencies, and parental decisions significantly delay neonatal cholestasis referrals.
- Enhanced education for healthcare professionals and parents regarding early referral is essential.
- Universal infant stool color screening in Malaysia could improve outcomes for biliary atresia.
Aims:
To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.
Methods:
A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia.
Results:
Thirty-one of the 65 (43%) patients studied encountered delay or had an inappropriate action taken before referral. Factors leading to delayed referral, which adversely affected the outcome of biliary atresia (BA) and neonatal acute liver failure, were repeated reassurances by medical and paramedical staff (n = 17, 26%), failure of hospital services at the referring hospital (n = 7, 11%) and parental refusal for referral (n = 5, 8%). Only three (14%) of the 22 patients who developed liver failure had liver transplantation (LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-year survival rate (native liver and LT) was 41%.
Conclusions:
Repeated false reassurance, failure of hospital services and parental refusal all contributed to delayed referral in neonatal cholestasis. In addition to education of medical and public health workers, and parents on the importance of early referral in neonatal cholestasis, health authorities in Malaysia should consider the feasibility of universal stool colour screening in newborn infants to improve the outcome of BA.
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