VALUE OF SONOGRAPHY IN PROLONGED NEONATAL JAUNDICE - FINDINGS IN 13 CASES

Background. - Different conditions are associated with a prolonged cho lestatic jaundice in the neonatal period: viral hepatitis biliary atre sia and choledocal cyst are the most frequent causes. Laboratory findi ngs are necessary, although they do not permit an etiologic diagnosis in all cases. Serial ultrasonographic study could be proposed for the evaluation of biliary excretion before and after feeding, in order to differentiate between these three conditions. Patients and methods. - Between February 1993 and January 1997, 13 newborns (seven girls and s ix boys) aged from 30 to 186 days, presented with jaundice and conjuga ted hyperbilirubinemia. They were evaluated by laboratory tests; seria l ultrasonographic examinations were performed after 4 hours fasting t hen 1 and 2 hours after meal. Results. - The gallbladder (GB) was visu alized in nine patients. In five of these patients, it contracted afte r feeding suggesting the diagnosis of neonatal hepatitis, that was con firmed by the clinical evolution. In three patients, the GB did not ch ange in size and the diagnosis of biliary atresia was surgically pr ov en. In one patient, a choledocal cyst was visualized and confirmed by surgery. The GB was not identified after 4 hours of fasting in four pa tients; biliary atresia was suspected and confirmed by surgery. Conclu sion. - Serial ultrasound of the GB is art easy and non-invasive metho d. It was useful in identifying those conditions requiring surgery in eight patients. We recommend its use as the initial method in the eval uation of neonatal jaundice before the other invasive methods. (C) 199 8, Elsevier, Paris.