Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical signs and symptoms suggesting biliary atresia in a neonate presenting with cholestasis include:
- Persistent conjugated hyperbilirubinaemia beyond 2 weeks of age, manifesting as prolonged jaundice with pale or acholic stools and dark urine, is a hallmark feature NICE CG98 Feldman & Mack 2015.
- Hepatomegaly may be present on abdominal examination due to liver inflammation and fibrosis NICE CG98 Orłowska et al. 2017.
- Failure to thrive or poor weight gain can be observed as a consequence of malabsorption related to cholestasis NICE CG98 Fawaz et al. 2017.
- Absence of improvement or worsening of jaundice despite supportive care is a clinical red flag NICE CG98 Feldman & Mack 2015.
- Onset typically within the first 2 months of life, with jaundice persisting beyond the neonatal period, differentiates biliary atresia from physiological jaundice NICE CG98 Fawaz et al. 2017.
These clinical features, especially pale stools and persistent conjugated hyperbilirubinaemia, should prompt urgent referral for further diagnostic evaluation including liver function tests, imaging, and possibly liver biopsy to confirm biliary atresia NICE CG98 Orłowska et al. 2017Feldman & Mack 2015.
Key References
- CG98 - Jaundice in newborn babies under 28 days
- (Feldman and Mack, 2015): Biliary Atresia: Clinical Lessons Learned.
- (Fawaz et al., 2017): Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
- (Orłowska et al., 2017): [Biliary atresia - signs and symptoms, diagnosis, clinical management].