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Value of bile acid determination for the diagnosis of neonatal jaundice
J Pawłowska1, Z Bogoniowska, M Szczygielska-Kozak
1Child Health Center, Warszawa, Poland.
Insights
This study found higher serum bile acids and bilirubin in infants with extrahepatic cholestasis. Cholestyramine effectively lowered these levels in infants under 10 weeks with intrahepatic cholestasis.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Neonatal Medicine
Background:
- Prolonged jaundice in infants necessitates understanding underlying causes.
- Bile acid and bilirubin levels are key indicators of liver function and cholestasis.
Purpose of the Study:
- To investigate serum and duodenal bile acid and bilirubin levels in infants with prolonged jaundice.
- To evaluate the efficacy of cholestyramine in treating intrahepatic cholestasis in infants.
Main Methods:
- Analysis of serum and duodenal bile acid and bilirubin concentrations in 90 infants (aged 1-44 weeks).
- Measurement of alanine transferase and alkaline phosphatase activity.
- Assessment of cholestyramine's effect on serum markers in infants with intrahepatic cholestasis.
Main Results:
- Infants with extrahepatic cholestasis showed significantly elevated serum bile acids and bilirubin.
- Cholestyramine significantly reduced serum bile acids and bilirubin in infants under 10 weeks with intrahepatic cholestasis.
- Bile acids were absent or minimal in duodenal contents of infants with biliary tract obstruction.
Conclusions:
- Serum bile acid and bilirubin levels are valuable diagnostic markers for infantile cholestasis.
- Early intervention with cholestyramine may be beneficial for intrahepatic cholestasis in young infants.
- Absence of duodenal bile acids indicates severe biliary obstruction.
Abstract:
Serum concentrations of bile acids and bilirubin, and activity of alanine transferase and alkaline phosphatase as well as bile acid and bilirubin levels in duodenal contents were determined in 90 infants aged 1-44 weeks (including 49 under 10 weeks of age) admitted to hospital for prolonged jaundice. Infants with extrahepatic cholestasis were found to have statistically higher serum bile acid and bilirubin concentrations. Oral administration of cholestyramine produced a statistically significant decrease in serum bile acids and bilirubin in infants with intrahepatic cholestasis under 10 weeks of age. In 24 out of the 30 infants with biliary tract obstruction total absence of bile acids in the duodenal contents was demonstrated while in the others the concentration did not exceed 0.2 mmol/l. The mean bile acid concentration in infants with intrahepatic cholestasis was 2.81 mmol/l while in 8 infants out of the 60 bile acids were either absent or present in trace amounts. The method had an 84.4% sensitivity.