Initially diagnosed with physiological jaundice, An continued to nurse well without fussiness. However, after 4 weeks, his yellowing skin prompted his family to seek further consultation at the Tam Anh General Clinic in District 7. Dr. Phan Thi Tuong Van, a pediatrician, noted that An's direct bilirubin levels were 40% (normal is below 20%). This indicated jaundice due to cholestasis, but the underlying cause needed identification for proper treatment.

First, an ultrasound ruled out biliary atresia. According to Dr. Van, this is the most common and dangerous surgical cause of cholestasis in newborns. It involves the scarring and blockage of bile ducts outside the liver, requiring surgery within the crucial 6-8 week period. Fortunately, An's ultrasound was clear. Next, Dr. Van prescribed a week-long medication trial to differentiate between hepatitis and a genetic metabolic disorder. During this period, An's family diligently recorded his skin, urine, and stool color for diagnostic monitoring.

A follow-up appointment revealed positive results: An's skin color improved, and his liver enzyme and bilirubin levels decreased, indicating a good response to the medication. Dr. Van concluded that An had neonatal hepatitis, likely caused by a viral or other infection affecting bile secretion. He was prescribed a 6-12 month course of medication to improve liver function.

Cholestatic jaundice results from blocked bile flow from the liver to the small intestine. This blockage prevents bile and direct bilirubin from reaching the intestines, causing them to accumulate in the liver and seep into the bloodstream. This elevated direct bilirubin concentration causes jaundice. The condition's initial similarity to physiological jaundice, which arises from the immature liver's inability to efficiently remove bilirubin, makes it easily misdiagnosed.

An infant undergoing phototherapy for physiological jaundice. Photo illustration: Tam Anh General Hospital

An infant undergoing phototherapy for physiological jaundice. Photo illustration: Tam Anh General Hospital

Besides yellowing skin and eyes, infants with cholestatic jaundice may exhibit pale stools, dark yellow or brown urine, itching, abdominal distension, an enlarged liver, slow weight gain, and malnutrition.

Without prompt diagnosis and treatment, prolonged cholestasis can lead to irreversible liver damage, cirrhosis, and liver failure. It also impairs nutrient absorption, particularly fats and essential vitamins, resulting in severe malnutrition.

Dr. Van advises parents to seek medical attention if their newborn's jaundice persists beyond 4 weeks for formula-fed babies and 6 weeks for breastfed babies, even if the infant is feeding well.

Dinh Lam

*The patient's name has been changed