The objective of this study was to study etiologies and outcome of neonatal
cholestasis in Thai infants. The medical records of infants aged less than 3 months with the diagnosis of neonatal
cholestasis in Department of Pediatrics, Siriraj Hospital from 1993 to 2004 were retrospectively reviewed. The etiologies were diagnosed by history, physical examination, and proper investigations. There were 252 infants, including 135 males (53.6%) and 117 females (46.4%). The etiologies of
cholestasis were idiopathic
neonatal hepatitis (INH) 23%,
extrahepatic biliary atresia (EHBA) 22.2%,
total parenteral nutrition (TPN)-related
cholestasis 18.3%,
infection 9.9%, endocrine causes 6%,
choledochal cyst 5.6%,
Down syndrome 4.4%,
hemolytic anemia 1.6%, and miscellaneous causes 9.1%, respectively. TPN-related
cholestasis was increasingly found due to advance management of
critically ill premature infants. Inborn error of metabolism were suspected in 8 patients (3.21%). Seventeen cases (6.7%) developed
cholestasis during the first week of life due to
hemolytic anemia, intrauterine
infection,
hypoxia and others. During the 3 month follow-up period, 6 cases died of progressive dysfunction of liver and one case with idiopathic
neonatal hepatitis died from intracranial
bleeding from
vitamin K deficiency. In conclusion, INH and EHBA are the most common causes of neonatal
cholestasis. Due to advance management and
nutritional support in
critically ill premature infants, TPN-related
cholestasis is found more often. Inborn error of metabolism related to neonatal
cholestases is uncommon in Thai infants. Overall short-term prognosis of neonatal
cholestases is good.