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Brain imaging in children with neonatal cholestatic liver disease: A systematic review
Thora Wesenberg Helt1, Lars Søndergaard Johansen2, Daniel Faurholt-Jepsen3,4
1Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.
Insights
Neonatal cholestasis in children can cause brain imaging abnormalities, potentially impacting neuropsychological development. Further research is needed to understand the exact causes of these impairments.
Area of Science:
- Pediatric Neurology
- Hepatology
- Medical Imaging
Background:
- Neonatal cholestatic liver disease is a serious condition in infants.
- Impaired neuropsychological development is a concern in affected children.
- Brain imaging plays a crucial role in assessing neurological impact.
Approach:
- A comprehensive literature search was conducted using Ovid MEDLINE and EMBASE.
- Studies included children under 18 with neonatal cholestasis and brain scans.
- Data on demographics, imaging findings, treatment, and outcomes were extracted and summarized.
Key Points:
- Hemorrhage was the most frequent brain imaging finding in children with neonatal cholestasis.
- Bile duct obstruction, particularly biliary atresia, was associated with a higher incidence of hemorrhage.
- Some brain imaging abnormalities resolved following liver transplantation.
Conclusions:
- Neonatal cholestasis is associated with brain imaging changes in children.
- These changes may contribute to impaired neuropsychological development.
- Longitudinal studies with structured assessments are required to clarify the etiology.
Aim:
To determine if children with neonatal cholestatic liver disease had concurrent and later findings on brain imaging studies that could be attributed and the cholestasis to contribute to the understanding of the impaired neuropsychological development.
Methods:
Ovid MEDLINE and EMBASE were searched on July 21, 2022, and updated on March 26, 2023. Studies with children under 18 years of age with neonatal cholestasis and a brain scan at the time of diagnosis or later in life were included. Excluded studies were non-English, non-human, reviews or conference abstracts. Data were extracted on demographics, brain imaging findings, treatment and outcome. The results were summarised by disease categories. Risk of bias was assessed using JBI critical appraisal tools.
Results:
The search yielded 12 011 reports, of which 1261 underwent full text review and 89 were eligible for inclusion. Haemorrhage was the most common finding, especially in children with bile duct obstruction, including biliary atresia. Some findings were resolved after liver transplantation.
Conclusion:
Children with neonatal cholestasis had changes in brain imaging, which might play a role in impaired neuropsychological development, but longitudinal clinical research with structured assessment is needed to better qualify the aetiology of the impairment.
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