Etiology of Neonatal Cholestasis: An Experience in a Tertiary Centre of Bangladesh

Salahuddin Mahmud1, Syed Shafi Ahmed2, Mashud Parvez 3, Farhana Tasneem4 , Mahenaz Afroz5

Abstract
Background: Neonatal cholestasis is a major cause of morbidity & mortality in
young infants. It has a varied etiology and difficult diagnostic problem. The disorder
has rarely been studied in centers from Bangladesh.
Objective: To determine the etiology of both extra-hepatic & intra-hepatic cholestasis
at a tertiary referral center in Bangladesh.
Materials & Methods: A prospective, descriptive study was done in the department
of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children)
Hospital, Dhaka, Bangladesh from January 2014 to June 2016 among 80 infants who
presented with cholestatic jaundice in <1 year of age.
Results: Out of 80 children, 48 (60%) were intra-hepatic causes & 32 (40%) were
extra-hepatic causes. Among all cholestasis, biliary atresia (BA) 30 (37.5%), idiopathic
neonatal hepatitis (INH) 20 (25%) and TORCH infections 19 (23.7%) were the
commonest ones. Among 32 extra-hepatic cholestasis, predominant causes were biliary
atresia 30 (93.7%) followed by choledochal cyst 2 (5.3%). In 48 Intra-hepatic cholestasis,
idiopathic neonatal hepatitis (INH) 20 (41.6%) and TORCH infections 19 (39.5%)
were the dominant ones. Two (4.1%) cases of hypothyroidism, galactosemia and intrahepatic
bile duct paucity (non-syndromic) each. Down’s syndrome with
hypothyroidism, urinary tract infection (UTI) with sepsis and progressive familial
intra-hepatic cholestasis (PFIC) were evaluated in 1 (2%) case of each. Among 19
TORCH infections, Cytomegalovirus (CMV) 13 (68.4%) was the commonest followed
by CMV with herpes-simplex virus (HSV) co-infection 4 (21.1%) and Toxoplasmosis 2
(10.5%).
Conclusion: The more frequent etiological factors were biliary atresia (BA), idiopathic
neonatal hepatitis (INH) & TORCH infections. CMV were predominant cause of TORCH
infections.
Key words: Neonatal cholestasis, cholestatic jaundice, biliary atresia, Idiopathic
neonatal hepatitis, Conjugated hyperbilirubinemia.

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