Schimmel Marein, Kneepkens C M Frank, de Meij Tim J G
Amsterdam UMC, afd. Kindergeneeskunde, Amsterdam.
Contact: M. Schimmel (
Ned Tijdschr Geneeskd. 2019 Jul 23;163:D3691.
In every neonate presenting with prolonged jaundice persisting beyond day 21 of life, neonatal cholestasis should always be excluded even if the infant is breast fed. Pale stools are an alarm symptom and additional tests for neonatal cholestasis should be carried out directly.
We describe the case of a five-week-old girl of Chilean origin who was referred with conjugated hyperbilirubinaemia. The jaundice had possibly arisen directly after birth, but due to the dark skin colour of the neonate the jaundice was not recognized as such, although her scleras were yellow. According to the stool colour card, her stools were pale. The findings of a histological examination of a liver biopsy confirmed the diagnosis of biliary atresia, for which a Kasai hepatoportoenterostomy was performed.
Neonatal cholestasis is always pathological and requires further investigation. In infants with dark skin, jaundice is sometimes difficult to see and inspection of the scleras should give the definitive answer.
对于每一位出生21天后仍有持续性黄疸的新生儿，即使是母乳喂养，也应始终排除新生儿胆汁淤积症。大便颜色变浅是一个警示症状，应直接对新生儿胆汁淤积症进行进一步检查。
我们描述了一名来自智利的5周大女孩的病例，她因结合胆红素血症前来就诊。黄疸可能在出生后就直接出现了，但由于新生儿肤色较深，尽管她的巩膜发黄，但黄疸并未被识别出来。根据大便颜色卡，她的大便颜色变浅。肝活检的组织学检查结果证实了胆道闭锁的诊断，并为其实施了Kasai肝门肠吻合术。
新生儿胆汁淤积症总是病理性的，需要进一步检查。对于皮肤黝黑的婴儿，有时很难发现黄疸，检查巩膜应能给出明确答案。
