Neonatal Cholestasis (नवजात शिशु में कोलेस्टेसिस) एक condition है जिसमें शिशु के liver से bile (पित्त) का प्रवाह बाधित हो जाता है।
- सामान्यतः newborn में 2–3 सप्ताह के बाद अगर जॉन्डिस (पीलापन) persistent रहता है तो cholestasis का संदेह होता है।
- यह condition bile duct, liver cells या metabolic disorders के कारण हो सकती है।
- Early diagnosis critical है क्योंकि untreated cholestasis liver damage और growth failure का कारण बन सकता है।
Neonatal Cholestasis क्या है (What is Neonatal Cholestasis)
- Bile flow impairment in neonates (< 3 months old)
- Leads to accumulation of bile acids, bilirubin, causing jaundice
- Common signs: persistent jaundice, dark urine, pale stools, hepatomegaly
- Serious cases में liver fibrosis, cirrhosis, or liver failure हो सकता है
Neonatal Cholestasis कारण (Causes of Neonatal Cholestasis)
1. Extrahepatic Biliary Atresia (most common cause)
- Bile ducts absent or blocked
- Requires surgical intervention (Kasai procedure)
2. Neonatal Hepatitis / Infectious Causes
- Viral: CMV, HSV, Hepatitis B
- Bacterial sepsis
3. Metabolic and Genetic Disorders
- Alpha-1 antitrypsin deficiency
- Galactosemia, Tyrosinemia
- Progressive familial intrahepatic cholestasis (PFIC)
4. Endocrine Causes
- Hypothyroidism
- Hypopituitarism
5. Drug-induced or Toxin-related
- Certain medications in mother or neonate
Neonatal Cholestasis लक्षण (Symptoms of Neonatal Cholestasis)
- Persistent jaundice (>2–3 weeks)
- Dark urine (due to bilirubin)
- Pale or acholic stools
- Poor weight gain or feeding difficulty
- Hepatomegaly (enlarged liver)
- Itching (pruritus) in some cases
- Failure to thrive in chronic cases
Early recognition is essential to prevent irreversible liver damage।
Neonatal Cholestasis कैसे पहचाने (Diagnosis of Neonatal Cholestasis)
- Clinical Examination – jaundice, hepatomegaly, stool color
- Laboratory Tests
- Total and direct (conjugated) bilirubin
- Liver function tests (AST, ALT, ALP, GGT)
- Metabolic panels (galactosemia, alpha-1 antitrypsin)
- Imaging Studies
- Ultrasound for bile ducts and liver anatomy
- HIDA scan to assess bile flow
- Liver Biopsy – confirm diagnosis in uncertain cases
- Genetic Testing – for suspected inherited metabolic disorders
Early referral to pediatric hepatologist is crucial।
Neonatal Cholestasis इलाज (Treatment of Neonatal Cholestasis)
1. Cause-specific Treatment
- Biliary Atresia – Kasai portoenterostomy surgery
- Metabolic Disorders – dietary modifications, enzyme replacement
- Infections – antiviral/antibiotic therapy
2. Supportive Management
- Nutritional support (high-calorie formula, fat-soluble vitamins A, D, E, K)
- Pruritus management (cholestyramine, ursodeoxycholic acid)
3. Liver Transplantation
- Indicated in progressive liver failure or uncorrectable biliary atresia
- Early intervention improves survival
रोकथाम (Prevention)
- Early screening for jaundice in newborns
- Manage maternal infections during pregnancy
- Early diagnosis and treatment of metabolic disorders
- Avoid unnecessary neonatal exposure to hepatotoxic drugs
सावधानियाँ (Precautions)
- Monitor bilirubin levels regularly in jaundiced infants
- Ensure adequate nutrition and hydration
- Follow up with pediatric hepatologist
- Seek urgent care for persistence of jaundice, pale stools, dark urine, or poor feeding
FAQs (अक्सर पूछे जाने वाले प्रश्न)
Q1. Neonatal cholestasis कितने common है?
लगभग 1 in 2500 live births में होता है।
Q2. क्या यह life-threatening हो सकता है?
हाँ, untreated cases में liver fibrosis, cirrhosis, या liver failure हो सकता है।
Q3. कितनी जल्दी surgery करनी चाहिए?
Biliary atresia में first 2 months में Kasai surgery सबसे effective होती है।
Q4. क्या breastfed babies में भी हो सकता है?
हाँ, लेकिन breast milk jaundice अलग होती है, cholestasis में direct bilirubin elevated होता है।
निष्कर्ष (Conclusion)
Neonatal Cholestasis (नवजात शिशु में कोलेस्टेसिस) एक गंभीर liver condition है, जो persistent jaundice और liver dysfunction का कारण बन सकती है।
Early diagnosis, cause-specific treatment, nutritional support और timely surgical intervention से outcomes बेहतर होते हैं।
अगर किसी newborn में persistent jaundice, pale stools, या dark urine दिखे, तो तुरंत pediatric hepatologist से consultation जरूरी है।