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Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country
Aim: To study the accuracy of various clinical and investigational parameters to differentiate biliary atresia (BA) from neonatal hepatitis (NH). Methods: It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this st...
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| Published in: | Acta Paediatrica 2009-08, Vol.98 (8), p.1260-1264 |
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| container_title | Acta Paediatrica |
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| creator | Poddar, Ujjal Thapa, Babu Ram Das, Ashim Bhattacharya, Anish Rao, KL Narasimha Singh, Kartar |
| description | Aim: To study the accuracy of various clinical and investigational parameters to differentiate biliary atresia (BA) from neonatal hepatitis (NH).
Methods: It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this study. Following a baseline hepatobiliary scintigraphic study (HBS), it was repeated after giving UDCA (40 mg/kg/day for 48–72 h). The sensitivity and specificity of clinical and investigational parameters were calculated with peroperative cholangiogram as gold standard.
Results: The mean age was 2.8 ± 1.7 months and 82 were male. Of these, 35 were diagnosed to have BA and 66 had NH (idiopathic 25, sepsis/UTI 20, galactosaemia 11, TORCH 2 and others 8). Persistently clay stool was found to have modest accuracy (79%) and the accuracy of HBS improved significantly following UDCA therapy (91% from 77%, p < 0.01) whereas liver biopsy was 100% accurate in differentiating BA from NH. The outcome of BA cases with ductal plate malformation (DPM) was worse.
Conclusion: One‐third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA. |
| doi_str_mv | 10.1111/j.1651-2227.2009.01338.x |
| format | article |
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Methods: It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this study. Following a baseline hepatobiliary scintigraphic study (HBS), it was repeated after giving UDCA (40 mg/kg/day for 48–72 h). The sensitivity and specificity of clinical and investigational parameters were calculated with peroperative cholangiogram as gold standard.
Results: The mean age was 2.8 ± 1.7 months and 82 were male. Of these, 35 were diagnosed to have BA and 66 had NH (idiopathic 25, sepsis/UTI 20, galactosaemia 11, TORCH 2 and others 8). Persistently clay stool was found to have modest accuracy (79%) and the accuracy of HBS improved significantly following UDCA therapy (91% from 77%, p < 0.01) whereas liver biopsy was 100% accurate in differentiating BA from NH. The outcome of BA cases with ductal plate malformation (DPM) was worse.
Conclusion: One‐third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA.</description><identifier>ISSN: 0803-5253</identifier><identifier>EISSN: 1651-2227</identifier><identifier>DOI: 10.1111/j.1651-2227.2009.01338.x</identifier><identifier>PMID: 19469771</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Biliary atresia ; Biliary Atresia - complications ; Biliary Atresia - diagnosis ; Biological and medical sciences ; Biopsy ; Chi-Square Distribution ; Cholagogues and Choleretics - therapeutic use ; Cholangiography ; Cholestasis ; Cholestasis - drug therapy ; Cholestasis - etiology ; Developing Countries ; Diagnosis, Differential ; Digestive system ; Ductal plate malformation ; Feces ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Hepatitis - complications ; Hepatitis - diagnosis ; Humans ; India ; Infant, Newborn ; Investigative techniques, diagnostic techniques (general aspects) ; Liver - pathology ; Liver biopsy ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Other diseases. Semiology ; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques ; Prospective Studies ; Radionuclide Imaging ; Sensitivity and Specificity ; Ursodeoxycholic Acid - therapeutic use</subject><ispartof>Acta Paediatrica, 2009-08, Vol.98 (8), p.1260-1264</ispartof><rights>2009 The Author(s)/Journal Compilation © 2009 Foundation Acta Pædiatrica</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5328-dd080fc536e7c25c14b16b5b8cca1f71efb55ad66e50730e7f8117f1c30ed6133</citedby><cites>FETCH-LOGICAL-c5328-dd080fc536e7c25c14b16b5b8cca1f71efb55ad66e50730e7f8117f1c30ed6133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1651-2227.2009.01338.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1651-2227.2009.01338.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21673381$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19469771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poddar, Ujjal</creatorcontrib><creatorcontrib>Thapa, Babu Ram</creatorcontrib><creatorcontrib>Das, Ashim</creatorcontrib><creatorcontrib>Bhattacharya, Anish</creatorcontrib><creatorcontrib>Rao, KL Narasimha</creatorcontrib><creatorcontrib>Singh, Kartar</creatorcontrib><title>Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country</title><title>Acta Paediatrica</title><addtitle>Acta Paediatr</addtitle><description>Aim: To study the accuracy of various clinical and investigational parameters to differentiate biliary atresia (BA) from neonatal hepatitis (NH).
Methods: It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this study. Following a baseline hepatobiliary scintigraphic study (HBS), it was repeated after giving UDCA (40 mg/kg/day for 48–72 h). The sensitivity and specificity of clinical and investigational parameters were calculated with peroperative cholangiogram as gold standard.
Results: The mean age was 2.8 ± 1.7 months and 82 were male. Of these, 35 were diagnosed to have BA and 66 had NH (idiopathic 25, sepsis/UTI 20, galactosaemia 11, TORCH 2 and others 8). Persistently clay stool was found to have modest accuracy (79%) and the accuracy of HBS improved significantly following UDCA therapy (91% from 77%, p < 0.01) whereas liver biopsy was 100% accurate in differentiating BA from NH. The outcome of BA cases with ductal plate malformation (DPM) was worse.
Conclusion: One‐third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA.</description><subject>Biliary atresia</subject><subject>Biliary Atresia - complications</subject><subject>Biliary Atresia - diagnosis</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Chi-Square Distribution</subject><subject>Cholagogues and Choleretics - therapeutic use</subject><subject>Cholangiography</subject><subject>Cholestasis</subject><subject>Cholestasis - drug therapy</subject><subject>Cholestasis - etiology</subject><subject>Developing Countries</subject><subject>Diagnosis, Differential</subject><subject>Digestive system</subject><subject>Ductal plate malformation</subject><subject>Feces</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Hepatitis - complications</subject><subject>Hepatitis - diagnosis</subject><subject>Humans</subject><subject>India</subject><subject>Infant, Newborn</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Liver - pathology</subject><subject>Liver biopsy</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques</subject><subject>Prospective Studies</subject><subject>Radionuclide Imaging</subject><subject>Sensitivity and Specificity</subject><subject>Ursodeoxycholic Acid - therapeutic use</subject><issn>0803-5253</issn><issn>1651-2227</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkU-P0zAQxS0EYrsLXwH5ArcE_4ntBIlDVdgFqVpAAiHtxXKcMXVxk66dQvvtcWgpR_BlRvLvjZ_fIIQpKWk-L9cllYIWjDFVMkKaklDO63L_AM3OFw_RjNSEF4IJfoEuU1oTwnhTycfogubSKEVnaHULQ29GE7BdDQHSaJJPr3DnnYMI_ejN6IceDw63PngTD9iMEZI32MVhg_s_6hVsMzn6hH2PDe7gB4Rh6_tv2A67foyHJ-iRMyHB01O9Ql-u335evCuWH27eL-bLwgrO6qLrsmmXewnKMmFp1VLZira21lCnKLhWCNNJCYIoTkC5mlLlqM19J3MKV-jFce42Dve7_CG98clCCCZ73SUtVVWTilb_BBmhDWtUncH6CNo4pBTB6W30mxyFpkRP69BrPaWup9T1tA79ex16n6XPTm_s2g10f4Wn_DPw_ASYZE1w0fTWpzPHqFR50sS9PnI_fYDDfxvQ84_zqcv64qj3aYT9WW_i9xwIV0J_vb3Rd58WyzeKS33HfwEyAbZ6</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Poddar, Ujjal</creator><creator>Thapa, Babu Ram</creator><creator>Das, Ashim</creator><creator>Bhattacharya, Anish</creator><creator>Rao, KL Narasimha</creator><creator>Singh, Kartar</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country</title><author>Poddar, Ujjal ; Thapa, Babu Ram ; Das, Ashim ; Bhattacharya, Anish ; Rao, KL Narasimha ; Singh, Kartar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5328-dd080fc536e7c25c14b16b5b8cca1f71efb55ad66e50730e7f8117f1c30ed6133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Biliary atresia</topic><topic>Biliary Atresia - complications</topic><topic>Biliary Atresia - diagnosis</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Chi-Square Distribution</topic><topic>Cholagogues and Choleretics - therapeutic use</topic><topic>Cholangiography</topic><topic>Cholestasis</topic><topic>Cholestasis - drug therapy</topic><topic>Cholestasis - etiology</topic><topic>Developing Countries</topic><topic>Diagnosis, Differential</topic><topic>Digestive system</topic><topic>Ductal plate malformation</topic><topic>Feces</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Hepatitis - complications</topic><topic>Hepatitis - diagnosis</topic><topic>Humans</topic><topic>India</topic><topic>Infant, Newborn</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Liver - pathology</topic><topic>Liver biopsy</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques</topic><topic>Prospective Studies</topic><topic>Radionuclide Imaging</topic><topic>Sensitivity and Specificity</topic><topic>Ursodeoxycholic Acid - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poddar, Ujjal</creatorcontrib><creatorcontrib>Thapa, Babu Ram</creatorcontrib><creatorcontrib>Das, Ashim</creatorcontrib><creatorcontrib>Bhattacharya, Anish</creatorcontrib><creatorcontrib>Rao, KL Narasimha</creatorcontrib><creatorcontrib>Singh, Kartar</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta Paediatrica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poddar, Ujjal</au><au>Thapa, Babu Ram</au><au>Das, Ashim</au><au>Bhattacharya, Anish</au><au>Rao, KL Narasimha</au><au>Singh, Kartar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country</atitle><jtitle>Acta Paediatrica</jtitle><addtitle>Acta Paediatr</addtitle><date>2009-08</date><risdate>2009</risdate><volume>98</volume><issue>8</issue><spage>1260</spage><epage>1264</epage><pages>1260-1264</pages><issn>0803-5253</issn><eissn>1651-2227</eissn><notes>ArticleID:APA1338</notes><notes>istex:42937194FFB4B95A4F6A4EC3E36AB936EB3FAC21</notes><notes>ark:/67375/WNG-ZQCLD736-Z</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Aim: To study the accuracy of various clinical and investigational parameters to differentiate biliary atresia (BA) from neonatal hepatitis (NH).
Methods: It was a prospective study, conducted in a tertiary care hospital. A total 101 infants with neonatal cholestasis (NCS) were included in this study. Following a baseline hepatobiliary scintigraphic study (HBS), it was repeated after giving UDCA (40 mg/kg/day for 48–72 h). The sensitivity and specificity of clinical and investigational parameters were calculated with peroperative cholangiogram as gold standard.
Results: The mean age was 2.8 ± 1.7 months and 82 were male. Of these, 35 were diagnosed to have BA and 66 had NH (idiopathic 25, sepsis/UTI 20, galactosaemia 11, TORCH 2 and others 8). Persistently clay stool was found to have modest accuracy (79%) and the accuracy of HBS improved significantly following UDCA therapy (91% from 77%, p < 0.01) whereas liver biopsy was 100% accurate in differentiating BA from NH. The outcome of BA cases with ductal plate malformation (DPM) was worse.
Conclusion: One‐third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19469771</pmid><doi>10.1111/j.1651-2227.2009.01338.x</doi><tpages>5</tpages></addata></record> |
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| subjects | Biliary atresia Biliary Atresia - complications Biliary Atresia - diagnosis Biological and medical sciences Biopsy Chi-Square Distribution Cholagogues and Choleretics - therapeutic use Cholangiography Cholestasis Cholestasis - drug therapy Cholestasis - etiology Developing Countries Diagnosis, Differential Digestive system Ductal plate malformation Feces Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Hepatitis - complications Hepatitis - diagnosis Humans India Infant, Newborn Investigative techniques, diagnostic techniques (general aspects) Liver - pathology Liver biopsy Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Other diseases. Semiology Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques Prospective Studies Radionuclide Imaging Sensitivity and Specificity Ursodeoxycholic Acid - therapeutic use |
| title | Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country |
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