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Neonatal Cholestasis
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Conjugated hyperbilirubinemia → US splits the workup.
Decision
Outcome
Decision
Newborn with dark urine, acholic stools, conjugated hyperbilirubinemia. First test?
✓
Abdominal ultrasound
✗
MRI brain
✗
Empiric phenobarbital
Decision
Ultrasound finding?
✓
Abnormal or absent gallbladder → biliary atresia workup
✓
Cystic dilation of biliary tree → choledochal cyst
✓
Isolated hepatomegaly or normal → infectious + genetic/metabolic workup
Outcome
Biliary atresia → HIDA scan, intraoperative cholangiogram, Kasai portoenterostomy
Outcome is best if Kasai performed before 8 weeks of life.
Outcome
Choledochal cyst → surgical excision (risk of cholangiocarcinoma)
Outcome
Targeted workup for CMV, toxoplasmosis, HSV, sepsis/UTI; AAT, Dubin-Johnson, galactosemia, CF, tyrosinemia