Forthcoming Issue 2 2024 An Audit of Infants Presenting with Cholestatic Jaundice at a Secondary Hospital in Johannesburg, South Africa
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Abstract
Background: Neonatal cholestatic jaundice is a common paediatric condition with a paucity of recent local data and a notable absence of locally influenced diagnostic algorithms.
Objectives: To describe the causes of cholestatic jaundice, investigations conducted and patient outcomes.
Methods: This was a retrospective file review of 96 patients presenting to the Gastrointestinal (GIT) Specialist Clinic at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg between 01 January 2014 and 31 December 2020. Clinical features, serum biochemistry at presentation, diagnostic investigations (haematological, radiological and histological), diagnosis and outcome were analysed during data collection.
Results: Ninety-six patients were included in the study. The median age of jaundice onset was at two months, while the median age of presentation was 3.3 months. Causes of jaundice fell into three main categories; 38 had biliary atresia (BA), 24 had another specific diagnosis, but 34 remained without an underlying diagnosis (idiopathic neonatal hepatitis). An overall mortality rate of 26% was noted at a median age of 13 months (IQR 5;24), and was highest in the BA group (n= 14, 56%).
Conclusion: The evaluation of neonatal jaundice requires a wide differential and expeditious referral to optimise outcomes and avoid complications. Many patients remained undiagnosed, and the overall prognosis was poor. The authors recommend the development of a locally relevant diagnostic protocol to minimise delays in the identification, diagnosis and treatment of neonatal jaundice.
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