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Clinical features differentiating biliary atresia from other causes of neonatal cholestasis.
MedLine Citation:
PMID:  20838708     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: This study determined any clinical features which may help to differentiate biliary atresia (BA) from other causes of neonatal cholestasis (NC).
MATERIALS AND METHODS: A prospective and observational study was conducted on consecutive infants with NC referred to the University of Malaya Medical Centre, Malaysia, between November 1996 and May 2004.
RESULTS: The 3 most common causes of cholestasis among the 146 infants with NC studied were idiopathic neonatal hepatitis (n = 63, 43%), BA (n = 35, 24%) and congenital cytomegalovirus hepatitis (n = 13, 9%). Common clinical features at presentation were jaundice (100%), hepatomegaly (95%), splenomegaly (52%) and pale stools (47%). Three clinical features noted to be sensitive for BA were the presence of acholic or variably acholic stools on admission, a liver which was firm/hard in consistency and a palpable liver of ≥4 cm (sensitivity of 77%, 80% and 94%, respectively), but the corresponding specificity was poor (51%, 65% and 39%, respectively). The stools of 2 children with BA were pigmented initially but became acholic subsequently.
CONCLUSIONS: We did not find any single clinical feature with sufficient sensitivity and specificity to differentiate BA from other causes of NC. Repeated inspection of stools colour is necessary as occasionally, patients with BA may have initial pigmented stools. Biochemical assessment and imaging studies are important in the assessment of any infant with NC.
Authors:
Way Seah Lee; Pei Fan Chai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the Academy of Medicine, Singapore     Volume:  39     ISSN:  0304-4602     ISO Abbreviation:  Ann. Acad. Med. Singap.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-09-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503289     Medline TA:  Ann Acad Med Singapore     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  648-54     Citation Subset:  IM    
Affiliation:
Departments of Paediatrics, University of Malaya Medical Centre, Malaysia. leews@um.edu.my
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