Guideline for the Evaluation of Cholestatic Jaundice in Infants: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Top Cited Papers
- 1 August 2004
- journal article
- guideline
- Published by Wiley in Journal of Pediatric Gastroenterology and Nutrition
- Vol. 39 (2), 115-128
- https://doi.org/10.1097/00005176-200408000-00001
Abstract
For the primary care provider, cholestatic jaundice in infancy, defined as jaundice caused by an elevated conjugated bilirubin, is an uncommon but potentially serious problem that indicates hepatobiliary dysfunction. Early detection of cholestatic jaundice by the primary care physician and timely, accurate diagnosis by the pediatric gastroenterologist are important for successful treatment and a favorable prognosis. The Cholestasis Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the diagnostic evaluation of cholestatic jaundice in the infant. The Cholestasis Guideline Committee, consisting of a primary care pediatrician, a clinical epidemiologist (who also practices primary care pediatrics), and five pediatric gastroenterologists, based its recommendations on a comprehensive and systematic review of the medical literature integrated with expert opinion. Consensus was achieved through the Nominal Group Technique, a structured quantitative method. The Committee examined the value of diagnostic tests commonly used for the evaluation of cholestatic jaundice and how those interventions can be applied to clinical situations in the infant. The guideline provides recommendations for management by the primary care provider, indications for consultation by a pediatric gastroenterologist, and recommendations for management by the pediatric gastroenterologist. The Cholestasis Guideline Committee recommends that any infant noted to be jaundiced at 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin. However, breast-fed infants who can be reliably monitored and who have an otherwise normal history (no dark urine or light stools) and physical examination may be asked to return at 3 weeks of age and, if jaundice persists, have measurement of total and direct serum bilirubin at that time. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition on the evaluation of cholestatic jaundice in infants. The American Academy of Pediatrics has also endorsed these recommendations. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all patients with this problem.This publication has 101 references indexed in Scilit:
- The ultrasonographic ‘triangular cord’ coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasisJournal of Pediatric Surgery, 1999
- Direct enzymatic assay of urinary sulfated bile acids to replace serum bilirubin testing for selective screening of neonatal cholestasisThe Journal of Pediatrics, 1996
- Users' Guides to the Medical LiteratureJAMA, 1994
- Diagnostic utility of hepatobiliary scintigraphy with 99mTc-DISIDA in neonatal cholestasisThe Journal of Pediatrics, 1987
- String test in evaluation of cholestatic jaundice in infancyThe Journal of Pediatrics, 1985
- Neonatal cholestasisThe Journal of Pediatrics, 1985
- Duodenal bile acids in diagnosis of congenital biliary atresiaJournal of Pediatric Surgery, 1983
- The infant with possible biliary atresia: Evaluation by ultrasound and nuclear medicinePediatric Radiology, 1982
- ReplyThe Journal of Pediatrics, 1980
- Diagnosis of biliary atresia: Relative accuracy of percutaneous liver biopsy, open liver biopsy, and operative cholangiographyThe Journal of Pediatrics, 1967