Rolling Stones: An Instructive Case of Neonatal Cholestasis

Authors

Paige Killelea
Shruti Sakhuja
Jose Hernandez
M John Hicks
Sanjiv Harpavat

Publication Date

9-4-2022

Journal

BMC Pediatrics

DOI

10.1186/s12887-022-03560-3

PMID

36058901

PMCID

PMC9441063

PubMedCentral® Posted Date

9-4-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Biliary Atresia, Choledocholithiasis, Cholestasis, Humans, Hyperbilirubinemia, Infant, Infant, Newborn, Infant, Newborn, Diseases, Jaundice, Neonatal, Liver Diseases, Male, Ursodeoxycholic Acid, Choledocholithiasis, Conjugated bilirubin, Biliary tree, Gallbladder, Case report

Abstract

BACKGROUND: Jaundice within the first 1-2 weeks of a neonate's life will generally self-resolve; however, if it lasts longer than this time frame it warrants further work up. Direct or conjugated hyperbilirubinemia can suggest neonatal cholestasis, which in turn reflects marked reduction in bile secretion and flow. The differential diagnosis for neonatal cholestasis is broad. Neonatal choledocholithiasis is a rare cause of neonatal cholestasis, but should be considered on the differential diagnosis for patients presenting with elevated conjugated bilirubin.

CASE PRESENTATION: We describe an infant who presented with neonatal cholestasis. He subsequently underwent work up for biliary atresia, as this is one of the more time-sensitive diagnoses that must be made in neonates with conjugated hyperbilirubinemia. He was ultimately found to have choledocholithiasis on magnetic resonance cholangiopancreatography. He was managed conservatively with optimizing nutrition and ursodeoxycholic acid therapy.

CONCLUSIONS: We found that conservative management, specifically optimizing nutrition and treating with ursodeoxycholic acid, can be a sufficient approach to facilitating resolution of the choledocholithiasis and conjugated hyperbilirubinemia.