Korean J Pediatr Gastroenterol Nutr.  2004 Sep;7(2):208-214.

Predictive Factors for Prognosis of Neonatal Intrahepatic Cholestasis: Non-Familial, Non-Metabolic, Non-Syndromic Cholestasis

• Kim HS
• Lee CH
• Kim IJ
• Park JH

Abstract

PURPOSE: The prognosis of neonates with cholestasis is not clear. Some factors, such as high peak bilirubin levels and liver histologic findings have been claimed to affect the prognosis adversely. Our study aims to define which factors influence the prognosis of neonatal intrahepatic cholestasis.
METHODS
Retrospective reviews of the medical records were performed in 32 cases with neonatal intrahepatic cholestasis, who were admitted to Department of Pediatrics, Pusan National University Hospital from July 1995 to July 2002. Neonates were classified into 2 groups according to the duration of elevated serum alanine aminotransferase (ALT) levels more or less than 6 months. The data, such as biochemical, histopathologic and radiologic findings, were compared in both groups. Biochemical data included mean peak level of serum ALT, total bilirubin, direct bilirubin, and alkaline phosphatase. Histologic parameters related to lobular architecture, fibrosis, inflammatory infiltration and degenerative features of hepatocytes were arbitrary estimated on a scale of 1 to 3.
RESULTS
There were 19 males and 13 females, whose mean age was 48 days (14~77 days). The peak serum ALT levels were higher in the poor outcome group. Ductular proliferation and portoportal bridging were more severe in the poor outcome group. But the degree of multinucleated hepatocytes, hepatocellular swelling and canalicular plug did not appear to be significantly related to the long-term outcome. The DISIDA scintigraphy by visualization time of gall bladder and intestine was not useful in predicting outcome of neonatal intrahepatic cholestasis.
CONCLUSION
Neonates who have intrahepatic cholestasis with high serum ALT levels, severe ductular proliferation and portoportal bridging in the liver biopsy specimen should be carefully followed up because they may have a poor prognosis.

Keyword

Neonatal cholestasis; Intrahepatic cholestasis; Neonate

MeSH Terms

Alanine Transaminase
Alkaline Phosphatase
Bilirubin
Biopsy
Busan
Cholestasis*
Cholestasis, Intrahepatic*
Female
Fibrosis
Hepatocytes
Humans
Infant, Newborn
Intestines
Liver
Male
Medical Records
Pediatrics
Prognosis*
Radionuclide Imaging
Retrospective Studies
Urinary Bladder
Alanine Transaminase
Alkaline Phosphatase
Bilirubin