Aetio-Clinical Profile of Cholestatic Jaundice During Infancy- Study of 30 Cases in a Tertiary Care Hospital

Cholestasis in young infants has a varied etiology. There is considerable delay in presentation of cholestatic cases, both in India (average delay of 3 months in referral centers) and Bangladesh (3.5 months). Early diagnosis is important as the effects of cholestasis are profound and wide-spread. EHBA comprises a significant proportion of cases of cholestatic diseases. If treatment of EHBA is delayed beyond the first 90 days of life, the only option thereafter is liver transplantation, which is not presently feasible on a large scale in developing countries. So, the aim and objective of this study is to determine the cause and to categorize the clinical profile and treatment options of conjugated hyperbilirubinaemia in infancy. A total of 30 patients, who fulfilled inclusion and exclusion criteria were included. A detailed history and physical examination was done daily. Complete blood count, liver function tests, HBsAg and TORCH screening, thyroid function test, Urine was tested for non-glucose reducing substances. Ultrasonography of the hepatobiliary system and hepatobiliary scintigraphy was done. Liver biopsy was done in appropriate patients. Patients were followed up daily during hospital stay. The management and its response were also monitored and recorded. Out of 30 patients 24 (80%) were male and 6 (20%) were female. 63% were term and 37% were preterm. Out of 12 patients in BA, 11 were term and only 1 was preterm, whereas in NH group, out of 18 babies, 10 were preterm. Most of the patients were male in both studied groups. Mean value of birth weight in BA was 2.65±0.13 and in NH was 2.40±0.31. Mean age (days) at onset of jaundice in 2 groups were 3.92 ± 2.43 in BA and 6.5 ±4.5 in NH. Most patients of BA (91%) had persistent acholic stool, whereas in Neonatal hepatitis group 83% had intermittent acholic stool. No statistically significant difference was observed when hepatosplenomegaly and ALT values were considered in 2 studied groups. In BA group 33% & In NH group 72% babies had positivity for CMV infection. Normal ultrasonic findings were seen in 2 patients of BA group, and 7 in NH group. No patient had shown contracted gall bladder after meal in BA, Choledocal cyst was found to be responsible for 5 (42%) patients in BA group and none in NH group. HIDA showed 47% had biliary atresia, 43% neonatal hepatitis and 10.0% had normal liver. Liver biopsy revealed that 12 (40.0%) had biliary atresia and 18 (60.0%) had neonatal hepatitis. Out of 12 babies in Biliary atresia group almost all, 11(92%) received surgical management where as in Neonatal hepatitis group; all 18 babies (100%) received medical treatments. Early detection of cholectatic cases by observing stool colour is very important for physicians to direct the very specific investigations to find out the cause and start appropriate treatment immediately. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18804 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 34-39

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Clinical outcome of infants younger than two months in children ward of a tertiary care hospital, Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v3i2.20269 ◽

2016 ◽

Vol 3 (2) ◽

pp. 15-18

Author(s):

Ganesh Shah ◽

Dinesh Dharel ◽

Anish K Shah ◽

Bikal Sapkota ◽

Asmita Bhattarai

Keyword(s):

Blood Culture ◽

Clinical Outcome ◽

Skin Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Facility ◽

Clinical Profile ◽

Care Hospital ◽

Young Infants ◽

Level Hospital

Introductions: Newborn and young infants are most vulnerable for preventable deaths, particularly in developing countries. This study was conducted to see the clinical profile and outcome of infants less than two months of age admitted in children ward of Patan Hospital.Methods: This descriptive retrospective study was conducted at Patan Hospital, over 12 months from April 2014 to March 2015. Hospital records of all admitted infants aged less than two months were reviewed. The demographic characteristics, clinical profile and clinical outcome were descriptively analyzed.Results: Out of 2062 admissions in children ward, 614 (29.8%) were infants aged less than two months, out of which 482 were neonates less than 28 days. Among these neonates, 114 were inborn. Out of 436 infections, blood culture was positive in 37 (8.9%). There were 4 (0.04%) deaths, 4 (0.04%) referral and 22 (0.25%) left against medical advice. Infection 436 (436) was the commonest cause of illness, of which neonatal sepsis was 163 (37.4%), pneumonia 130 (30%) staphylococcal skin infection 39 (8.7%) and UTI 34 (7.8%). There were 71 (11.6%) cases of neonatal hyperbilirubinemia. Blood culture was positive in 55 (9%) with CONS being the commonest organism isolated; 19 (51.3%).Conclusions: Children ward contributes significantly to the care of sick infants less than two months of age, especially out born ones, requiring neonatal care facility in tertiary level hospital of Nepal. As most admissions are for infection, followed by hyperbilirubinemia, pediatrics wards need to be equipped and staffed accordingly to meet the need of sick young infants.Journal of Patan Academy of Health Sciences. 2016 Dec;3(2):15-18

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A cross sectional study of clinical profile and evaluation of pulmonary hypertension in Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Mangalore, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20191136 ◽

2019 ◽

Vol 6 (2) ◽

pp. 330

Author(s):

Kshama S. Ramesh ◽

Devdas B. Rai ◽

Shayma Sheikh Abdulla ◽

Jyothsna B. K.

Keyword(s):

Pulmonary Hypertension ◽

Tertiary Care ◽

Clinical Profile ◽

Cardiac Complications ◽

Chronic Obstructive ◽

Close Monitoring ◽

Care Hospital ◽

Cross Sectional ◽

Copd Patients ◽

Significant Difference

Background: The objectives was to study the clinical profile of COPD patients and to evaluate pulmonary hypertension in COPD patients by non-invasive methods.Methods: A prospective observational study of patients who satisfy all inclusion and exclusion criteria in OPD or admitted in medical wards of AJIMS Mangalore. The study was conducted from October 2017 to October 2018 with the sample size of 90 subjectsResults: Out of 90 subjects 53 (58.8%) of them had pulmonary hypertension. Among the subjects who had pulmonary hypertension 29 (54.72%) of them had moderate pulmonary hypertension, 17 (32.08%) of them had severe pulmonary hypertension and 7 (13.20%) of them had mild pulmonary hypertension. Mean age among the subjects who had pulmonary hypertension was 64.24+7.62yrs and mean age among the subjects who didn’t had pulmonary hypertension was 51.87+8.97yrs. There was a statistically significant difference found between mean age and pulmonary hypertension. Mean duration of diseases among the subjects who had pulmonary hypertension was 8.13+1.74yrs and Mean duration of diseases among the subjects who didn’t had pulmonary hypertension was 5.36+1.98yrs. There was a statistically significant difference found between mean duration of disease and pulmonary hypertension.Conclusions: Due to high prevalence of pulmonary hypertension we suggest screening for the all COPD patients for cardiac complications. This will help in identifying the individual who requires close monitoring and also in reducing the mortality.

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Dia gnostic accuracy of the R-Factor in diff erentiating between neonatal hepatitis and biliary atresia in infants

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021143 ◽

2021 ◽

Vol 75 (2) ◽

pp. 143-148

Author(s):

Seyed Mohsen Dehghani ◽

Sadegh Mohammadi ◽

Iraj Shahramian ◽

Fateme Parooie ◽

Hadi Mirzaie ◽

...

Keyword(s):

Liver Biopsy ◽

Diagnostic Accuracy ◽

Biliary Atresia ◽

Predictive Value ◽

Gold Standard ◽

Roc Analysis ◽

Neonatal Hepatitis ◽

P Value ◽

R Factor ◽

Significant Difference

Introduction: Liver function test is a part of safe and aff ordable routine blood biochemical tests and provides useful information for the diagnosis and management of liver dysfunction. In this study we evaluated the value of the R factor in distinguishing between intrahepatic and extrahepatic causes of infant cholestasis. Methods: Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic value of the R factor in each group in comparison with liver biopsy as the gold standard of diagnosis. The data were analyzed using SPSS statistical software and P < 0.05 indicated a significant difference. Results: The study included 37 neonatal hepatitis patients (group A) and 25 biliary atresia patients (group B). The R factor was calculated using the (ALT patient/ULN)/(ALP patient/ULN) formula; ROC analysis revealed that if the R factor was ≤ 0.09 the patient diagnosis would be biliary atresia with high sensitivity (92%) (p-value = 0.001). The corresponding specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and area under the ROC curve (AUC) were 75.7%, 72%, 93%, 82% and 0.87, respectively. Conclusion: The study revealed that the R factor is a good diagnostic marker for differentiating between the most common intrahepatic and extrahepatic causes of infant cholestasis and has good diagnostic accuracy, sensitivity, specificity, PPV and NPV, in comparison with liver biopsy as the gold standard of diagnosis.

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Cholestatic Jaundice in Infants An Experience in Tertiary Care Hospital

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v32i1.21029 ◽

2014 ◽

Vol 32 (1) ◽

pp. 9-15 ◽

Cited By ~ 1

Author(s):

FR Chowdhury ◽

K Chowdhury ◽

ASMB Karim

Keyword(s):

Birth Weight ◽

Biliary Atresia ◽

Tertiary Care ◽

Age At Onset ◽

Cholestatic Jaundice ◽

Neonatal Hepatitis ◽

Biliary Cirrhosis ◽

Care Hospital ◽

Neonatal Cholestasis ◽

Cross Sectional

Background: Neonatal cholestasis is defined as prolonged elevation of serum levels of conjugated bilirubin beyond the first 14 days of life. Cholestasis in a newborn can be due to infectious, genetic, metabolic, or undefined abnormalities giving rise to mechanical obstruction of bile flow or to functional impairment of hepatic excretory function and bile secretion. Early detection and timely accurate diagnosis are important for successful treatment and a favorable prognosis. Objective: The present study has been designed to determine the etiology of cholestatic jaundice in infants along with their clinical profile. Methodology: This cross-sectional study was conducted from August 2010 through January 2011 in the Paediatric Gastroenterology & Nutrition Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. For the study purpose 40 consecutive cases of cholestatic jaundice were included who fulfilled the inclusion criteria. Result: Biliary atresia was the commonest (42.5%) cause of cholestatic jaundice followed by neonatal hepatitis/ idiopathic neonatal hepatitis. Other causes of cholestatic of the infants were term and of normal birth weight in cases of biliary atresia (BA) but in NH/INH group significant number of infants were preterm and of low birth weight. Mean age at onset of jaundice was 10.1 ± 4.18 days, and mean age at presentation was 113.7 ±15.38 days. In cases of BA Jaundice, intermittent / persistent pale stool, dark urine was found in all cases and hepatomegaly and splenomegaly were found in 88.2% and 64.8% of cases respectively. Ultrasonographically in most of the cases of BA gallbladder was found either small in size or absent or bile ducts were not visualized. In cases of NH/INH visualization of normal gallbladder while fasting and contraction was observed after meal. Histologically typical features BA were found in 12 out of 17 cases of BA and features of early biliary cirrhosis in 4 infants and 10 patients showed features of INH. Conclusion: Biliary atresia was found to be the commonest cause of neonatal cholestasis in the present study. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21029 J Bangladesh Coll Phys Surg 2014; 32: 9-15

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Clinical profile of dehydration fever in neonates in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190716 ◽

2019 ◽

Vol 6 (2) ◽

pp. 718

Author(s):

Muhammad Hassan ◽

Adarsh E. ◽

Rajanish K. V.

Keyword(s):

Weight Loss ◽

Birth Weight ◽

Urine Output ◽

Tertiary Care ◽

Clinical Profile ◽

Care Hospital ◽

Factors Affecting ◽

Medical College ◽

Significant Difference ◽

Daily Urine

Background: The aim of this study was to determine the clinical profile of neonates admitted with dehydration fever and ascertain the maternal and neonatal factors affecting it.Methods: A observational descriptive study was conducted at Rajarajeswari Medical College and hospital, population included neonates who were admitted in NICU with dehydration fever.Results: The study were conducted among 50 neonates admitted with dehydration fever. Majority of neonates (72%) were diagnosed with dehydration fever on day 3 of life. 84 % neonates were born to primiparous mothers. In the study there was significant difference in mean birth weight, weight at admission and percentage of weight loss between birth weight and weight at admission with respect to symptoms on presentation. Mean % of weight loss was 12.06 when dehydration fever was presented with fever, 11.29 when dehydration fever presented with decreased urine output, 18.44 when presented with both fever and decreased urine output and 12.73 when presented with jaundice these values were statistically significant.Conclusions: Dehydration fever occurs most commonly on day 3 or after, effective measures should be initiated for early diagnosis and prevention of complications like effective breast-feeding counselling, proper techniques, good latching and supplementation of artificial feeds if required and monitoring of daily weight and daily urine output.

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Usefulness of clinical and laboratory parameters for differentiation of biliary atresia from idiopathic neonatal hepatitis: Experience in a tertiary care hospital of Bangladesh

Community Based Medical Journal ◽

10.3329/cbmj.v4i1.53560 ◽

2015 ◽

Vol 4 (1) ◽

pp. 30-36

Author(s):

Kaniz Sultana ◽

Ariful Haque ◽

Nadira Musabbir ◽

Syeda Afria Anwar ◽

Faika Hussain ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Biliary Atresia ◽

Tertiary Care ◽

Neonatal Hepatitis ◽

Care Hospital ◽

Neonatal Cholestasis ◽

Cross Sectional ◽

Laboratory Parameters ◽

Upper Limit ◽

Idiopathic Neonatal Hepatitis

Background: The two most common and important causes of neonatal cholestasis (NC) are biliary atresia (BA) and Idiopathic neonatal hepatitis (INH). There is no single test that can definitely differentiate these two entities. Objective: To evaluate the diagnostic accuracy of clinical and laboratory parameters for diagnosis of biliary atresia. Methods: This cross-sectional study was conducted at the department of Pediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2013 through July 2015 among purposively sampled infants with neonatal cholestasis. Results: Total 86 neonatal cholestatic cases were studied. Term baby and good birth weight are significantly higher in BA cases. The presence of persistent pale colored stool is significantly more in patients with BA (p 0.000). GGT is the only liver enzyme that was found to be useful differentiating BA from INH at a cut-off value ≥ 524U/L or 9.5 times higher than upper limit normal with sensitivity and specificity of 81.6% and 72.9% respectively. In the present study the diagnostic accuracy of persistent pale colored stool found to be highest (79.1 %). Conclusion: The present study showed that Persistent pale colored stool and serum level of GGT with a cut-off value ≥524 U/L or 9.5 times higher than upper limit normal can be considered as predictive markers for differentiation of Biliary atresia from Idiopathic neonatal hepatitis. CBMJ 2015 January: Vol. 04 No. 01 P: 30-36

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