title: [Congenital extrahepatic biliary atresia as a cause of cholestasis in newborns and infants].
abstract: Congenital extrahepatic biliary atresia (CEBA) is one of the most common causes of cholestasis in newborns and infants.
  
  
  OBJECTIVE
  was the analysis of clinical presentation, results of laboratory and imaging investigations as well as clinical outcome of children with extrahepatic cholestasis caused by CEBA.
  
  
  METHODS
  the analyzed group included 15 children aged from 2 weeks to 4 months. Data concerning: pregnancy and delivery, newborn's health condition, faeces color; jaundice onset, manifestation of coagulation disorders coexisting malformations and disorders of other systems were obtained. The following investigations were performed: biochemical tests evaluating the function of the liver and cholestasis (serum bilirubin concentration and fractions, bile acids in serum, AlAT, AspAT, GGTP, FALK activities, serum electrophoresis, prothrombin index). We also performed tests focusing on hepatotropic infections, - metabolic disorders tests and in all children - ultrasound of the abdomen, scintigraphy of the bile ducts - HEPIDA. 14 children had undergone hepatoportoenterostomy, modo Kasai.
  
  
  RESULTS
  jaundice, acholic stools and hepatomegaly were present in all children. The serum concentration of bilirubin and its conjugated fraction and bile acids in all children were increased. GGTP and FALK activities were markedly elevated in all children. Aminotransferases activities elevations were observed, more distinctively for AST. Active cytomagalovirus infection was detected in 3 children. Abdominal ultrasound revealed gallbladder in 7 children, whereas intrahepatic bile ducts were described as normal in 12 cases. In all cases the HEPIDA scintigraphy showed no passage of the tracer to the GI tract even after 24 hours delay. Hepatoportoenterostomy was performed in 14 children, 5 of them had liver transplantation.
  
  
  CONCLUSIONS
  1. There is still not one effective and specific diagnostic method in differentiating between the causes of cholestasis in the newborns and infants. Thus many investigation methods should be run simultaneously. 2. Congenital atresia must be definitely excluded before cholestasis with other background is finally diagnosed. 3. The hepatoportoenterostomy should be considered as the first line treatment in children with CEBA. Most cases will need liver transplantation in the future.
authors.affiliation: Klinika Pediatrii, Gastroenterologii i Onkologii Dzieciecej, Akademia Medyczna, ul. Nowe Ogrody 1-6, 80-803 Gdansk, Poland. tlib@amg.gda.pl
authors.forename: Anna
authors.initials: A
authors.lastname: Liberek
authors.forename: Magdalena
authors.initials: M
authors.lastname: Góra-Gebka
authors.forename: Wanda
authors.initials: W
authors.lastname: Bako
authors.forename: Grazyna
authors.initials: G
authors.lastname: Sikorska-Wiśniewska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Szlagatys-Sidorkiewicz
authors.forename: Marek
authors.initials: M
authors.lastname: Królak
authors.forename: Andrzej
authors.initials: A
authors.lastname: Marek
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Jankowska
authors.forename: Maria
authors.initials: M
authors.lastname: Korzon
authors.forename: Piotr
authors.initials: P
authors.lastname: Czauderna
mesh_terms: D001647:Bile Acids and Salts / Q000032:analysis; D001656:Biliary Atresia / Q000150:complications* / Q000175:diagnosis*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D002648:Child; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis* / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000150:complications* / Q000175:diagnosis*
chemical_list: D001647:Bile Acids and Salts; D015415:Biomarkers; D001663:Bilirubin