scholarly journals Evaluation of Visual Examination of Stool as A Screening Test for Infant with Prolonged Neonatal Cholestasis Namely Biliary Atresia

2020 ◽  
Vol 39 (1) ◽  
pp. 46-52
Author(s):  
Mst Mukta Sarker ◽  
ASM Bazlul Karim ◽  
Soma Halder
Keyword(s):  
Biliary Atresia ◽  
Predictive Value ◽  
Screening Test ◽  
Portal Tract ◽  
Neonatal Cholestasis ◽  
Cross Sectional ◽  
Bile Duct Proliferation ◽  
Female Ratio ◽  
Dark Urine ◽  
Conjugated Bilirubin

Introduction: Neonatal cholestasis is a hepatobiliay disease characterized by biliary obstruction in the neonatal period. Biochemically it is evidenced by prolonged elevation of serum conjugated bilirubin beyond the first 14 days of life.1 Most common causes are biliary atresia and idiopathic neonatal hepatitis.3, 4 Objective: To evaluate stool color as a screening test by visual inspection in infants with prolonged neonatal cholestasis. Methodology: This was a cross-sectional analytic study, conducted in Pediatric Gastroenterology and Nutrition Department,BSMMU, Dhaka, from 3 September 2012 to 3 February 2013 about 6 month duration. Statistically calculated 38 infants with prolonged neonatal direct hyperbilirubinaemia beyond their 14 days of age were included in this study. Results: The mean age of the subjects was 62.3 days with a standard deviation (SD) ±13.7 days. Male to female ratio was 1.2:1. All (100%) the subjects were icteric and hepatomegaly was found in 94.7% subjects. Dark urine (84.2%), pale stool (78.5%), bleeding manifestations (31.8%) and infection (29%) were also observed. Thirty (78.5%) subjects had pale colored stool. Mean (± SD) albumin and conjugated bilirubin levels were 3.68 (±1.88)gm/dl and 5.29 (±1.31)mg/dl respectively. ALT and GGT level of the study subjects were 346.19±124.28 u/dl and 315±198.91 u/l respectively. Common ultrasonographic findings of the patients were non visualization of gallbladder 60.5%, non-visualization of common bileduct 50%, hepatomegaly 92.1%, and triangular cord sign in portahepatis 7.9%. Scintigraphy revealed impaired excretion into intestine 88.9% in majority of the subjects. Liver biopsy revealed liver architecture was preseved 65.8% bile duct proliferation 52.6%, regenarating nodule was absent 65.8% gaint cell was present 52.6% portal tract inflammation was found in 47.4%. Sensitivity of stool color in the diagnosis of neonatal cholestasis was found 90.6%, specificity 83.3%, accuracy 89.5%, positive predictive value 96.7% and negative predictive value 62.5%. Conclusion: It can be concluded that stool color might be reliable indicator for screening of prolonged neonatal cholestasis namely biliary atresia. J Bangladesh Coll Phys Surg 2021; 39(1): 46-52

scholarly journals Evaluating Specivity, Sensitivity, Positive and Negative Predictive Values of CA125 for Diagnosing Ovarian Cancer

2021 ◽  
Vol 24 (2) ◽  
pp. 196-203
Author(s):  
Elahe Fini ◽  
◽  
Neda Nasirian ◽  
Bahram Hosein Beigy ◽  
◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Positive Predictive Value ◽  
Tumor Marker ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
High Sensitivity ◽  
Medical Community ◽  
Cross Sectional ◽  
Predictive Values

Background and Aim: Ovarian cancer is among the most common cancers in women worldwide. CA125 is the most frequent biomarker used in the screening for ovarian cancer. CA125 has no high sensitivity and specificity as a screening test in the medical community; however, because of being simple and noninvasive, it is almost always requested for evaluation and ruling out cancer. It plays an important role in the treatment and post-treatment process, the prediction of prognosis, and the relapse of the disease. The present study aimed to determine the relationship between a high level of CA125 tumor marker and ovarian cancer by detecting spesivity, sensivity, positive and negative predictive values. Methods & Materials: In this cross-sectional study, all cases undergoing CA125 test in Velayat Hospital in 2017-1028 were evaluated for having ovarian cancer. In addition, the CA125 level was compared between healthy individuals and patients with ovarian cancer. Finally, the obtained data were analyzed using SPSS. Ethical Considerations: The present study was approved by the Qazvin University of Medical Sciences (Ethics Code: IR.QUMS.REC.1396.316). Results: In this study, 35.3% of the study participants received a definite diagnosis of ovarian cancer. Generally, CA125 values were negative in 41.8% and positive in.58.2% of the study subjects. The sensitivity of the test was measured as 80.1%, the specivity as 53.6%, the positive predictive value equaled 48.4%, and the negative predictive value was measured as 83%. There was a significant relationship between age and the presence of ovarian cancer, and serum CA125 levels. Conclusion: The present study suggested that age and the serum level of CA125 were statistically significant. Finally, CA125 levels were significantly related to ovarian cancer. It provided moderate specivity and specivity as well as low positive predictive value and high negative predictive value as a tumor marker; it is valuable for ruling out of tumor but not appropriate as a screening test.

scholarly journals Role of Multidetector Computerised Tomography in Evaluation of Proptosis

2019 ◽  
Vol 9 (2) ◽  
pp. 24-31
Author(s):  
Elina Shrestha ◽  
Narayan Bikram Thapa ◽  
Shankar Bahadur Singh Rajbhandari
Keyword(s):  
Predictive Value ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Computerised Tomography ◽  
Cross Sectional ◽  
Female Ratio ◽  
Male Female Ratio ◽  
One Year ◽  
Female Male Female

Introduction: Proptosis is defined as bulging of eye anteriorly out of the orbit. Our main objective was to analyze the pattern of computerised tomographic findings in evaluation of proptosis. Computerised tomography (CT) is noninvasive, easily accessible, affordable and reliable imaging which helps in early diagnosis and prompt treatment. Methods: A descriptive cross sectional study of total 58 patients presenting with proptosis referred to our department of radiology for computerised tomography evaluation during one year period were undertaken into study. The clinical information provided by ophthalmologist also helped our study to derive into conclusion. SPSS version 20 software was used for statistical data analysis. Results: Out of 58 patients, the most common cause of proptosis was neoplasm constituting of 25 cases (43.1%). Retinoblastoma was the commonest orbital tumor. Out of remaining cases, 15 (25.8%) were infective, 14 (24.1%) were inflammatory, two (3.44%) were traumatic and remaining two cases (3.44%) had no definitive cause for proptosis. Bilateral proptosis was commonly associated with thyroid ophthalmopathy. Among the subjects 32 were male, 26 were female. Male: Female ratio was 1:1.23. Age group was ranging from 1 month to 73 years.Mean age was 26.4 ± 22 years. Conclusions: Computerised tomography has an important role in distinguishing the different types of lesions based on their characteristics, location and extension prior to undertaking definitive surgical and medical treatment. Overall accuracy of CT in our study was 81%, sensitivity of 82.6%, specificity of 80.6%, positive predictive value of 76% and negative predictive value of 86.2%.

scholarly journals Etiologies of neonatal cholestasis at a tertiary hospital in Bangladesh

2020 ◽  
Vol 60 (2) ◽  
pp. 66-70
Author(s):  
Md. Benzamin ◽  
Mukesh Khadga ◽  
Fahmida Begum ◽  
Md. Rukunuzzaman ◽  
Md. Wahiduzzaman Mazumder ◽  
...  
Keyword(s):  
Biliary Atresia ◽  
Parvovirus B19 ◽  
Final Diagnosis ◽  
Tertiary Hospital ◽  
Neonatal Cholestasis ◽  
Lipid Storage Disease ◽  
Female Ratio ◽  
Varicella Zoster ◽  
Male Female Ratio ◽  
Torch Infection

Background Neonatal cholestasis is an important etiology of chronic liver disease in young children. It has a varied etiology. There is considerable delay in presentation and diagnosis of neonatal cholestasis in Bangladesh. Lack of awareness and knowledge among the pediatricians regarding etiological diagnosis and outcome of neonatal cholestasis is the reasons for poor outcome in major portion of cases in Bangladesh. Objective To evaluate the etiological spectrum of neonatal cholestasis. Methods This retrospective study was conducted at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. We reviewed medical records of children who were diagnosed with neonatal cholestasis. Complete diagnostic profiles of every cases with age of presentation, male-female ratio and final diagnosis were analyzed. Results A total of 114 children with neonatal cholestasis were evaluated. Subjects’ male-female ratio was 1.92: 1.0, and mean age at hospitalization was 92.7 (SD 39.5) days. Biliary atresia was the most common etiology (47.4%), followed by idiopathic neonatal hepatitis/INH (21.9%). Other identified etiologies were, toxoplasmosis, others (syphilis, varicella-zoster, parvovirus b19), rubella, cytomegalovirus (CMV), and herpes/TORCH infection (8.61%), progressive familial intrahepatic cholestasis/PFIC (4.4%), galactosemia (4.4%), choledochal cyst (3.5%),  sepsis (1.8%), urinary tract infection/UTI (1.8%), hypothyroidism (1.8%), lipid storage disease/Niemann-Pick disease (0.9%), non-syndromic paucity of interlobular bile ducts (2.67%), and Caroli’s disease (0.9%). Conclusion  In Bangladesh, neonatal cholestasis cases are most often due to obstructive causes, particularly biliary atresia. Idiopathic (INH), infectious (primarily TORCH), metabolic, and endocrine causes followed in terms of frequency.

scholarly journals Development of the Brief Bedside Dysphagia Screening Test – Revised: a Cross-Sectional Czech Study

2015 ◽  
Vol 58 (2) ◽  
pp. 49-55 ◽  
Author(s):  
Petra Mandysová ◽  
Edvard Ehler ◽  
Jana Škvrňáková ◽  
Michal Černý ◽  
Iva Bártová ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Screening Test ◽  
High Sensitivity ◽  
Endoscopic Examination ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Neurological Conditions ◽  
Nose And Throat

Aim: The purpose of this study was to develop a revised version of the Brief Bedside Dysphagia Screening Test for determining penetration/aspiration risk in patients prone to dysphagia. The priority was to achieve high sensitivity and negative predictive value. Methods: The study screeners conducted bedside assessment of the swallowing function in 157 patients with a neurological (mainly stroke) or an ear, nose, and throat diagnosis (mainly head and neck cancer). The results were compared with a gold standard, flexible endoscopic examination of swallowing. Results: For the neurological subgroup (N = 106), eight statistically significant bedside assessment items were combined into the Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). Cut-off score 1 produced the highest sensitivity (95.5%; 95% confidence interval CI [CI]: 84.9–98.7%) and negative predictive value (88.9%; 95% CI 67.2–96.9%). Conclusion: The BBDST-R is suitable for dysphagia screening in departments caring for patients with neurological conditions.

scholarly journals Magnetic resonance cholangiopancreatography as a diagnostic tools to diagnose biliary atresia at Dr.Soetomo hospital

2019 ◽  
Vol 3 (2) ◽  
pp. 137
Author(s):  
Gina Noor Djalilah ◽  
Reny Widayanti ◽  
Bagus Setyoboedi ◽  
Sjamsul Arief
Keyword(s):  
Magnetic Resonance ◽  
Liver Biopsy ◽  
Biliary Atresia ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Diagnostic Value ◽  
Diagnostic Tools ◽  
Diagnostic Study ◽  
Cross Sectional

ABSTRACT Cholestasis jaundice results from diminished bile flow and/or excretion, and caused by a number of disorders such as biliary atresia (BA). Magnetic resonance cholangiopancreatography (MRCP) is widely accepted as one of the modalities for biliary system imaging; however, liver biopsy still generally used for BA diagnosis, especially in developing countries. This aim study was to evaluate the diagnostic value of biliary atresia from MRCP compared to the result of a liver biopsy. A cross-sectional for diagnostic study documented of hospitalized patients from June 2014 to June 2015. All patients had MRCP and liver biopsy examination. The collection of data including age, gender, clinical manifestation and the result of MRCP and liver biopsy with ROC to evaluate the sensitivity and specificity was done. Liver biopsy revealed of biliary atresia was made based on proliferation, degeneration, and fibrosis of bile ducts. ROC to evaluate the sensitivity and specificity was done. The sensitivity, specificity, negative predictive value, positive predictive value of MRCP in diagnosing BA were calculated. There were 16 patients enrolled in this study with a median age of diagnosis was 6 months old (range 3-11). There were nine female patients out of the 16 patient. The median age of jaundice onset was 5 days (range 2-14 days). All patients had hepatomegaly and splenomegaly. Histopathology from liver biopsy revealed biliary atresia in 12 patients. From the ROC curve, the sensitivity of MRCP was 87.5% and specificity 62.5% with PPV 70% and NPV 80%. Five patients underwent a Kasai procedure and revealed biliary atresia. MRCP is sensitive but not specific for diagnosing BA, and MRCP has moderate sensitivity and specificity for BA diagnosis.Keyword: biliary atresia, magnetic resonance cholangiopancreatography, liver biopsy, diagnostic test.Correspondence: [email protected] ABSTRAKIkterus dikarenakan kolestasis terjadi akibat berkurangnya aliran empedu dan/ atau ekskresi, dan dapat disebabkan oleh sejumlah gangguan seperti atresia biliaris (BA). Magnetic resonance cholangiopancreatography (MRCP) secara luas diterima sebagai salah satu modalitas untuk pencitraan sistem empedu, namun biopsi hati masih secara umum digunakan untuk diagnosis BA, terutama di negara berkembang. Studi ini bertujuan untuk mengevaluasi nilai diagnostik atresia biliaris dari MRCP ke hasil biopsi hati. Sebuah cross sectional untuk studi diagnostik didokumentasikan pasien rawat inap dari Juni 2014 hingga Juni 2015. Semua pasien menjalani MRCP dan pemeriksaan biopsi hati. Data usia, jenis kelamin, manifestasi klinis dan hasil MRCP dan biopsi hati dengan ROC untuk mengevaluasi sensitivitas dan spesifisitas dilakukan. Biopsi hati mengungkapkan atresia biliar dibuat berdasarkan proliferasi, degenerasi dan fibrosis saluran empedu. ROC untuk mengevaluasi sensitivitas dan spesifisitas yang dilakukan. Dilakukan perhitungan sensitivitas, spesifisitas, nilai prediktif negatif, nilai prediksi positif MRCP dalam mendiagnosis BA. Terdapat 16 pasien yang terdaftar dalam penelitian ini dengan median usia diagnosis adalah 6 (kisaran 3-11) bulan. Terdapat 9 perempuan dari 16 pasien tersebut. Usia rata-rata onset penyakit kuning adalah 5 (kisaran 2-14) hari. Semua pasien mengalami hepatomegali dan splenomegali. Histopatologi dari biopsi hati mengungkapkan atresia bilier pada 12 dari 16 pasien. Dari kurva ROC, sensitivitas MRCP adalah 87,5% dan spesifisitas 62,5% dengan PPV 70% dan NPV 80%. Lima pasien menjalani prosedur Kasai dan mengungkapkan atresia bilier. MRCP sensitif namun tidak spesifik untuk mendiagnosis BA dan MRCP memiliki sensitivitas dan spesifisitas sedang untuk diagnosis BA.Kata kunci: biliary atresia, magnetic resonance cholangiopancreatography, liver biopsy, diagnostic test.Korespondensi: [email protected]

The Role of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Biliary Atresia: 14 Years' Experience

2017 ◽  
Vol 28 (03) ◽  
pp. 261-267 ◽  
Author(s):  
Ahmed Negm ◽  
Claus Petersen ◽  
Andrea Markowski ◽  
Birgit Luettig ◽  
Kristina Ringe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Diagnosis ◽  
Liver Biopsy ◽  
Biliary Atresia ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Predictive Value ◽  
Neonatal Cholestasis ◽  
Endoscopic Retrograde ◽  
Ultrasound Findings

Introduction Biliary atresia (BA) is a rare destructive inflammatory obliterative cholangiopathy of neonates. Early diagnosis is important in disease management. The aim was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing BA in a large cohort. In addition, we evaluated whether parameters such as bile trace, GGT, bilirubin, and laboratory values in combination can be used to develop a risk score that could indicate the referral to specialized centers. Materials and Methods All infants with neonatal cholestasis (2000–2014) who presented to our endoscopy unit for suspected BA were included. Demographics, laboratory parameters, ultrasound findings, liver biopsy results, ERCP diagnosis, and surgical outcome were collected. Value and safety of ERCP and risk factors for BA were retrospectively analyzed. Results We included 251 infants in our cohort (55% males, median age: 53 days). BA was intraoperatively diagnosed in 155 (83.4%) patients and was excluded in 30 (16.2%). Fifty-six cases were not operated due to the ERCP findings. ERCP was successful in 224/251 patients (89.2%) with no procedure-related complications. The operative and endoscopic diagnosis matched in 96.6% of the patients (positive predictive value: 92.2%, negative predictive value: 97.1%). In comparison to cases with excluded BA, the ones with this disease were significantly associated with absence of duodenal bile traces (98.4 vs. 1.6%, p < 0.001), higher bilirubin (p < 0.001, cutoff 7.3 mg/dL), and higher GGT (p < 0.001, cutoff 250 U/L). Conclusion ERCP is safe and accurate in the hands of experts in diagnosing BA if the cause of cholestasis is unclear. While evaluating the role of ERCP for diagnosing this disease, we found that the secondary parameters GGT > 250 U/L, bilirubin > 7.3 mg/dL (125 μmol/L), and the absence of bile traces are risk factors.

scholarly journals Cardiotocography in early labour: a screening test for predicting fetal outcome

2020 ◽  
Vol 10 (1) ◽  
pp. 321
Author(s):  
Vinothini Anandabaskar ◽  
Hiremath P. B. ◽  
Sanjeevkumar B. ◽  
Nivedhana Arthi ◽  
Rathnapratheep R.
Keyword(s):  
Predictive Value ◽  
Screening Test ◽  
False Positive Rate ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Lateral Position ◽  
Fetal Outcome ◽  
Careful Examination ◽  
Cross Sectional ◽  
Early Labour

Background: Fetal surveillance during labour is important to ensure delivery of a healthy baby with minimum intervention. Various parameters can be used to assess the fetal wellbeing like fetal movements perceived by the mother and monitoring of fetal heart rate. The objective of this study is to evaluate the efficacy of cardiotocography in early labour in predicting fetal outcome.Methods: A prospective hospital based cross sectional study was conducted on a total of 160 antenatal women in early labour with gestational age ≥ 37 weeks of gestation. Cardiotocogram was recorded for 20 minutes with the antenatal women in left lateral position. They are followed up till delivery and the mode of delivery of the baby was recorded. After delivery of the baby, the presence of fetal distress was assessed by careful examination of the neonate and colour of liquor.Results: Among the antenatal women, cardiotocography findings were normal in 74.4%, suspicious in 15% and pathological in 10.6%. The sensitivity of CTG in evaluating fetal outcome was found to be 84.6%, and the specificity was found to be 85.8%. The positive predictive value was 53.7% and the negative predictive value was 96.6%.Conclusions: Hence from the above study, it is can be concluded that the false positive rate of CTG is higher. Hence CTG cannot be used a sole indicator of fetal hypoxia. But in a resource limited setting, CTG is definitely a good screening test to predict the fetal outcome.

scholarly journals Cholestatic Jaundice in Infants – An Experience in Tertiary Care Hospital

2014 ◽  
Vol 32 (1) ◽  
pp. 9-15 ◽  
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

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

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

scholarly journals Etiological factors of cholestasis ininfancy andearly childhood in Children Welfare Teaching Hospital

2019 ◽  
Vol 61 (1) ◽  
pp. 6-10
Author(s):  
Mohammad Fadhil Ibraheem ◽  
Adnan Y. Mahmood ◽  
Jasim M. Salih
Keyword(s):  
Early Childhood ◽  
Biliary Atresia ◽  
Teaching Hospital ◽  
Unknown Origin ◽  
Neonatal Cholestasis ◽  
Cross Sectional ◽  
Congenital Infections ◽  
E Coli ◽  
Infancy And Early Childhood ◽  
Children Welfare

A Background: Neonatal cholestasis is defined as prolonged elevation of the serum level of conjugated bilirubin beyond the first 14 days of life. There are many causes of neonatal cholestasis which must be  identified because early intervention may result in a better outcome , such as surgical intervention in biliary atresia within two months from birth , or effective dietary management in metabolic disorders like  galactosemia. Objective:To determine the causes of early childhood cholestasis in children attending the Children Welfare Teaching Hospital in Baghdad and to study some of associated factors in infancy and early childhood  cholestasis. Patient and method: This is a cross sectional descriptive study conducted on 48 patients attending the  Children Welfare Teaching Hospital in Baghdad for the period of 1Novembe r 2015 to 15 January 2016. These cases were evaluated by thorough history, examination and investigations. Results:O the 48 patients enrolled in this study, 30 (62.5%) lived in Baghdad, and the remaining 37.5% were referred from other governorates .  the mean age of the patients was 11.1 ± 12.4 months, with 20 females (41.7%) and 28 males (58.3%). The  Results revealed that 11(22.9%)were the result of congenital infections , 9 (18.8%) were idiopathic in origin, 8 (16.7%) were caused by biliary atresia, 8 (16.7%) of unknown origin, 5 (10.4%) were caused by sepsis (mainly staphylococcus, streptococcus species, E coli, staphylococcus aureus) , 2 (4.2%) were caused by progressive familial intrahepatic cholestasis and 1 (2.1%) case was caused by each of the following causes: Alagille  snyndrome, Choledochal cyst, Galactosemia, hypothyroidism and Tyrosinemia. Conclusion: Congenital infections were the most common cause in this study, of which the most common is cytomegalovirus ( CMV ). Clay color stool and high alkaline phosphatase levels were found mostly in biliary  atresia. No method by itself is sufficient to diagnose the cause of neonatal cholestasis. D iagnosis can only be established using all available methods.

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