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Conjugated hyperbilirubinemia presenting in first fourteen days in term neonates

Fang Kuan Chiou1, Christina Ong1, Kong Boo Phua1

  • 1Gastroenterology Service, Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.

World Journal of Hepatology
|October 10, 2017
PubMed

Insights

Early-onset conjugated hyperbilirubinemia (ECHB) in neonates is often due to secondary liver injury, particularly in unwell infants. Biliary atresia can present atypically in well infants with ECHB.

Area of Science:

  • Neonatology
  • Pediatric Gastroenterology
  • Hepatology

Background:

  • Conjugated hyperbilirubinemia (CHB) in neonates requires prompt diagnosis.
  • Early-onset CHB (ECHB) presents within 14 days of life and necessitates understanding its diverse etiologies.
  • Differentiating ECHB from late-onset CHB (LCHB) is crucial for appropriate management.

Purpose of the Study:

  • To elucidate the causes and clinical features of early-onset conjugated hyperbilirubinemia (ECHB) in term neonates.
  • To compare the characteristics of ECHB with late-onset CHB (LCHB).

Main Methods:

  • Retrospective review of term infants with CHB (conjugated bilirubin [CB] >15% of total bilirubin and CB ≥25 μmol/L) within 28 days of life.
  • Categorization into ECHB (within 14 days) and LCHB (15-28 days).
  • Analysis of clinical presentation, etiology, and outcomes.

Main Results:

  • Of 117 infants, 65 had ECHB and 52 had LCHB.
  • ECHB infants were more likely to be clinically unwell (80.0% vs 42.3%) and have non-hepatic causes (73.8% vs 44.2%).
  • Multifactorial liver injury and sepsis were common in unwell ECHB infants; biliary atresia was frequent in well ECHB infants, often without pale stools.

Conclusions:

  • Secondary hepatic injury is the primary cause of ECHB.
  • Biliary atresia can manifest as ECHB in otherwise well neonates, lacking typical symptoms like pale stools.
Abstract

Keywords:
Biliary atresiaCholestasisConjugated hyperbilirubinemiaDirect hyperbilirubinemiaNeonatal jaundice

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