Neonatal Cholestasis

What is Neonatal Cholestasis?

Essentially, neonatal cholestasis is an infection of the liver. Infants with this condition have impaired bile flow from the liver cells to the intestine. 

When bile is restricted or blocked from your liver, it causes this condition. During digestion, bile assists in the breakdown of fats, especially from the liver. Alterations in bile flow can cause bilirubin to build up, the liver produces bilirubin and excretes it via your bile.

Neonatal cholestasis is most commonly used to describe a cholestatic liver disease that develops after birth and/or during the first few months of life. 

What are the Types of Neonatal Cholestasis

There are two types of cholestasis, one that occurs from inside the liver, and the other, that occurs from outside: 

• Intrahepatic Cholestasis: Originates within the liver. A variety of factors can contribute to this condition. These include infection, genetic abnormalities, and hormonal effects on bile flow.
• Extrahepatic Cholestasis: In this case, bile ducts are physically blocked. A blockage from gallstones, cysts, or tumours restricts bile flow.

What are the Symptoms of Neonatal Cholestasis

In newborns, the following symptoms and signs usually appear in the first two weeks of birth:

• Yellowing of the skin and eyes called jaundice
• The colour of urine gets dark
• Pale, grey stools
• Abdominal pain or swollen abdomen
• Tiredness or lethargy in the child
• liver enlargement
• Feeling nauseated, or vomiting
• Intense itchiness

If you see these signs, make sure to seek a healthcare provider for your child.

What can Cause Neonatal Cholestasis?

There are several causes, and they differ based on the source of the disease: 

Extrahepatic cholestasis can be caused by:

• Tumor in the bile duct
• Cancerous cysts in the duct
• Bile duct stones
• Bile duct narrowing 
• Nearby masses or tumours putting pressure on the bile ducts
• Tumor or pseudocyst of the pancreas
• Pancreatitis
• Cholangitis with primary sclerosing

Intrahepatic cholestasis can be caused by:

• Intravenous Feeding
• Liver abscess caused by bacteria
• Cirrhosis of the bile ducts
• Amyloidosis
• Metastatic or primary liver cancer
• Chronic sclerosing cholangitis
• Sarcoidosis
• Lymphoma
• Blood-borne infections (sepsis)
• Infection with tuberculosis
• Hepatitis

It is also possible that certain medicines may cause cholestasis, such as antibiotics, anabolic steroids, chlorpromazine, cimetidine, estradiol, imipramine, proschlorperazine, terbinafine, and tolbutamide, and even, birth control pills ingested by the mother.

When should you Contact a Medical Professional?

If you notice that the newborn shows jaundice-like symptoms, dark urine and/ or light stool- you should immediately contact a health provider. 

What are the Risk Factors associated with Neonatal Cholestasis?

Although any newborn infant can develop neonatal cholestasis, certain factors can make an infant much more susceptible to this disease. These include:

• Infection with bacteria,
• Viral infection
• Prolonged venous nutrition,
• Preterm birth.

What are the Possible Complications of Neonatal Cholestasis

Some patients can fully recover. However, others may suffer from secondary tissue injuries, malabsorption, anorexia, poor nutrient intake, hormonal disturbances, and malabsorption. If left untreated, it may lead to liver failure.

What are the Treatment Options for Neonatal Cholestasis 

Taking care of the underlying cause is the first step in treating cholestasis. Surgery may be recommended if an obstruction such as gallstones or a tumor is causing bile buildup.

Additionally, doctors may prescribe supplements of vitamins A, D, E, and K. The use of formulas high in medium-chain triglycerides should be recommended for infants with bile salt deficiencies. These medium-chain triglycerides are more readily absorbed. 

In severe cases, the calorie intake of the infant can be pushed up to 13 calories/kg/day and ursodeoxycholic acid can be administered to the child in small doses(10-15mg per day) to relieve itching.

Conclusion

Recognition of neonatal cholestasis is delayed in quite a few jaundiced infants’ cases- this is usually because healthcare professionals lack awareness about it. Neonatal cholestasis can be treated if spotted early. Delayed diagnosis can lead to severe complications and might even cause death. Surgery, vitamins, and supplements are all possible treatments for neonatal cholestasis.

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