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P50 Sensory Gating in Infants
Published on: December 26, 2013
[An infant with prolonged jaundice]
Marein Schimmel1,2, C M Frank Kneepkens3, Tim J G de Meij3
1Amsterdam UMC, afd. Kindergeneeskunde, Amsterdam.
Insights
Prolonged jaundice beyond 21 days in newborns requires investigation for neonatal cholestasis. Pale stools are a critical sign, necessitating immediate further testing, especially in infants with darker skin tones.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Hepatology
Background:
- Neonatal cholestasis is a serious condition requiring prompt evaluation.
- Prolonged jaundice, persisting beyond 21 days, warrants exclusion of neonatal cholestasis, irrespective of feeding method.
- Pale stools serve as a critical alarm symptom for neonatal cholestasis.
Observation:
- A case study of a five-week-old infant with conjugated hyperbilirubinemia is presented.
- Jaundice was initially unrecognized due to the infant's dark skin, despite yellow scleras.
- The infant presented with pale stools, confirmed by a stool color card.
Findings:
- Liver biopsy confirmed biliary atresia as the diagnosis.
- The infant underwent a Kasai hepatoportoenterostomy for treatment.
- Delayed recognition of jaundice in infants with dark skin highlights diagnostic challenges.
Implications:
- Neonatal cholestasis is always pathological and necessitates thorough investigation.
- Scleral inspection is crucial for jaundice detection in infants with dark skin.
- Early identification and intervention are vital for managing neonatal cholestasis and biliary atresia.
Background:
In every neonate presenting with prolonged jaundice persisting beyond day 21 of life, neonatal cholestasis should always be excluded even if the infant is breast fed. Pale stools are an alarm symptom and additional tests for neonatal cholestasis should be carried out directly.
Case Description:
We describe the case of a five-week-old girl of Chilean origin who was referred with conjugated hyperbilirubinaemia. The jaundice had possibly arisen directly after birth, but due to the dark skin colour of the neonate the jaundice was not recognized as such, although her scleras were yellow. According to the stool colour card, her stools were pale. The findings of a histological examination of a liver biopsy confirmed the diagnosis of biliary atresia, for which a Kasai hepatoportoenterostomy was performed.
Conclusion:
Neonatal cholestasis is always pathological and requires further investigation. In infants with dark skin, jaundice is sometimes difficult to see and inspection of the scleras should give the definitive answer.
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