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Review
. 2009 Dec;55(12):1184-92.

Early diagnosis of neonatal cholestatic jaundice: test at 2 weeks

Eric I Benchimol  1 , Catharine M Walsh, Simon C Ling
Affiliations
Review

Early diagnosis of neonatal cholestatic jaundice: test at 2 weeks

Eric I Benchimol et al. Can Fam Physician. 2009 Dec.

Abstract
in English, French

Objective: To review best practices for early recognition and treatment of conditions resulting in neonatal cholestasis, in order to improve long-term outcomes for affected infants.

Quality of evidence: Studies, review articles, and meta-analyses pertaining to neonatal-onset cholestasis were sought via electronic databases. Reference lists of studies and review articles supplemented the electronic search. Studies were included if they examined the importance of early diagnosis and intervention for cholestatic jaundice of any cause, and mainly comprised Level II and Level III evidence.

Main message: Review of the relevant literature supports the recommendation that infants with jaundice at 2 weeks of age should be tested for cholestasis by quantifying the direct reacting bilirubin levels in their blood. Subsequent rapid investigation using a diagnostic algorithm enables early diagnosis of the specific cause and facilitates timely intervention for conditions whose outcomes are improved by early treatment.

Conclusion: Universal screening for neonatal cholestasis might help with early identification of cases and improve outcomes, although further study is required in the North American setting.

OBJECTIF: Revoir les meilleures méthodes pour détecter et traiter précocement les conditions résultant de la cholestase néonatale afin d’améliorer les issues à long terme chez les nourrissons affectés.

QUALITÉ DES PREUVES: On a utilisé des bases de données pour répertorier les études, articles de revue et méta-analyses traitant de la cholestase néonatale. On a complété cette recherche électronique par des bibliographies d’études et d’articles de revue. On n’a retenu que les études traitant de l’importance de diagnostiquer et de traiter précocement toutes les formes d’ictère cholestatique et fondées sur des preuves de niveaux II et III.

PRINCIPAL MESSAGE: Cette revue de la littérature pertinente appuie la recommandation voulant qu’on recherche la cholestase chez les nourrissons qui présentent un ictère 2 semaines après la naissance par le dosage des niveaux de bilirubine conjuguée dans le sang. Une brève investigation subséquente à l’aide d’un algorithme de diagnostic permettra alors de préciser rapidement la cause et facilitera l’intervention appropriée dans les cas où une issue favorable dépend d’un traitement précoce.

CONCLUSION: Un dépistage systématique de la cholestase néonatale pourrait aider à détecter précocement les cas et en améliorer les issues; des études additionnelles seront toutefois nécessaires dans le contexte nord-américain.

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Figures

Figure 1
Figure 1
Algorithm for investigation of the neonate with cholestatic jaundice
See this image and copyright information in PMC

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