neonatology: best treatment? - dronacharya

[ArchivalUser]

18 day old male , full term delivery-uncomplicated pregnancy, develops jaundice,pale stool, formula fed, normal behavior for age. O/E: icterus upto sole, Vitals- normal for age, P/A: Hepatomegaly. others-Normal.
CBC/Electrolyte-N
T. Bilirubin-22
Direct-19
Coombs -ve
TSH-normal
Work up for inborn error-negative
Usg-hepatomegaly, Gall Bladder not visualised
Next step?
1. Liver biopsy and Surgery
2.HIDA scan
3.Liver Trl
4.exchange transfusion

[ArchivalUser]

2?

[ArchivalUser]

Already gall bladder is not visualized...that shows towards Biliary atresia...Confirm with liver biopsy and surgery...Liver biopsy shows proliferation of small bile ducts...bile plugs...and it helps to even rule out the neonatal hepatitis(idiopathic) which is also a possiblity here...(Biopsy is the most reliable test here...Hida more sensitive less specific)....We need to do urgent surgery in case of atresia because we loose significant proportion of hepatocytes everyday due to this process...and success with procedure is good with earliest possible surgery...

[ArchivalUser]

thanx