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新生儿胆汁淤积:一个潘多拉魔盒。

Neonatal Cholestasis: A Pandora's Box.

作者信息

Pandita Aakash, Gupta Vishal, Gupta Girish

机构信息

Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Department of Neonatology, Max Hospital, New Delhi, India.

出版信息

Clin Med Insights Pediatr. 2018 Dec 6;12:1179556518805412. doi: 10.1177/1179556518805412. eCollection 2018.

Abstract

Neonatal cholestasis (NC) is a diagnostic dilemma frequently countered in a neonatal care unit. Early diagnosis is vital for achieving an optimal patient outcome as many causes of cholestasis such as biliary atresia are time-sensitive and amenable to treatment if analyzed and treated early. Nonetheless, it is not generally simple to analyze these cases right on time as some of them are regularly missed due to the presence of pigmented stools, lack of newborn metabolic screening, and named as instances of prolonged jaundice. In this manner, we prescribe to explore all reasons for prolonged jaundice stretching out past 14 days in neonates. Besides, we suggest that stool card ought to be a piece of release rundown for all newborn children being released from the nursery. This is of most extreme significance in the nation like India where guaranteeing customary follow-up is as yet a tough assignment. These stool cards will help in the early determination of patients with NC particularly biliary atresia and guarantee their auspicious cure. Another reason which needs exceptional say is parenteral nutrition-associated liver illness, as the proportion of preterm babies is getting greater and greater with better neonatal care. These extreme preterm infants are in the requirement for prolonged (>14 days) total parenteral nourishment because of which they are at high hazard for NC contrasted with their more developed peers. In this survey, we will give an understanding of clinical approach, differential diagnosis, and clinical review of NC.

摘要

新生儿胆汁淤积症(NC)是新生儿重症监护病房中经常遇到的诊断难题。早期诊断对于实现最佳治疗效果至关重要,因为许多胆汁淤积症的病因,如胆道闭锁,具有时间敏感性,如果能早期分析和治疗,是可以治愈的。然而,及时分析这些病例通常并不简单,因为其中一些病例经常因出现色素性大便、缺乏新生儿代谢筛查而被漏诊,并被归类为持续性黄疸病例。因此,我们建议对新生儿持续超过14天的持续性黄疸的所有病因进行排查。此外,我们建议粪便卡片应成为所有从新生儿重症监护病房出院的新生儿出院清单的一部分。在像印度这样的国家,这具有极其重要的意义,因为确保定期随访仍然是一项艰巨的任务。这些粪便卡片将有助于早期诊断NC患者,尤其是胆道闭锁患者,并确保他们得到及时治疗。另一个需要特别提及的原因是肠外营养相关肝病,随着新生儿护理水平的提高,早产儿的比例越来越高。这些极早产儿由于需要长期(>14天)全肠外营养,因此与足月同龄人相比,患NC 的风险更高。在本综述中,我们将阐述NC的临床处理方法、鉴别诊断和临床评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bacb/6295748/9e720a78c09c/10.1177_1179556518805412-fig1.jpg

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