Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 64; no. 1; pp. 154 - 168
• Main Authors: Fawaz, Rima, Baumann, Ulrich, Ekong, Udeme, Fischler, Björn, Hadzic, Nedim, Mack, Cara L, McLin, Valérie A, Molleston, Jean P, Neimark, Ezequiel, Ng, Vicky Lee, Karpen, Saul J
• Format: Journal Article
• Language: English
• Published: United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01.01.2017
• Subjects: Biliary Atresia - complications; Biliary Tract; Bilirubin - blood; Cholestasis - blood; Cholestasis - diagnosis; Cholestasis - etiology; Cholestasis - pathology; Diagnosis, Differential; Europe; Gastroenterology; Humans; Hyperbilirubinemia - blood; Hyperbilirubinemia - diagnosis; Hyperbilirubinemia - etiology; Infant; Infant, Newborn; Jaundice - diagnosis; Jaundice - etiology; Jaundice, Obstructive - blood; Jaundice, Obstructive - diagnosis; Jaundice, Obstructive - etiology; Liver; Liver Diseases - blood; Liver Diseases - diagnosis; Liver Diseases - pathology; Medicin och hälsovetenskap; North America; Pediatrics; Societies
• DOI: 10.1097/MPG.0000000000001334
• ISSN: 0277-2116; 1536-4801

ABSTRACTCholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (BA, 25–40%) followed by an expanding list of monogenic disorders (25%), plus many unknown or multifactorial (e.g., parenteral nutrition related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these Guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature as well as the combined experience of the authors. The Committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dl or >17 μmol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad-based next generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including BA, leading to improved outcomes.