Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin St., Mark Wallace Tower Suite 1010, Houston, TX, 77030, USA.
Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin St., Mark Wallace Tower Suite 1010, Houston, TX, USA.
BMC Pediatr. 2022 Sep 4;22(1):526. doi: 10.1186/s12887-022-03560-3.
Jaundice within the first 1-2 weeks of a neonate's life will generally self-resolve; however, if it lasts longer than this time frame it warrants further work up. Direct or conjugated hyperbilirubinemia can suggest neonatal cholestasis, which in turn reflects marked reduction in bile secretion and flow. The differential diagnosis for neonatal cholestasis is broad. Neonatal choledocholithiasis is a rare cause of neonatal cholestasis, but should be considered on the differential diagnosis for patients presenting with elevated conjugated bilirubin.
We describe an infant who presented with neonatal cholestasis. He subsequently underwent work up for biliary atresia, as this is one of the more time-sensitive diagnoses that must be made in neonates with conjugated hyperbilirubinemia. He was ultimately found to have choledocholithiasis on magnetic resonance cholangiopancreatography. He was managed conservatively with optimizing nutrition and ursodeoxycholic acid therapy.
We found that conservative management, specifically optimizing nutrition and treating with ursodeoxycholic acid, can be a sufficient approach to facilitating resolution of the choledocholithiasis and conjugated hyperbilirubinemia.
新生儿生命的头 1-2 周内出现的黄疸通常会自行消退；然而，如果持续时间超过这个时间框架，则需要进一步检查。直接或结合胆红素升高提示新生儿胆汁淤积症，这反过来反映了胆汁分泌和流动的明显减少。新生儿胆汁淤积症的鉴别诊断范围很广。新生儿胆总管结石是新生儿胆汁淤积症的罕见病因，但对于出现结合胆红素升高的患者，应在鉴别诊断中考虑到这一点。
我们描述了一名患有新生儿胆汁淤积症的婴儿。他随后接受了胆道闭锁的检查，因为这是新生儿结合性高胆红素血症中必须做出的更具时间敏感性的诊断之一。他最终在磁共振胰胆管造影术上发现了胆总管结石。他通过优化营养和熊去氧胆酸治疗进行保守治疗。
我们发现，保守治疗，特别是优化营养和用熊去氧胆酸治疗，可以是促进胆总管结石和结合性高胆红素血症消退的有效方法。
