Cholestasis in neonates with fetal growth restriction

Abstract

Background: Neonatal Cholestasis (NC) is a sign of hepatobiliary disorder due to various etiologies. In the neonatal intensive care unit (NICU) extensive evaluvation is done to rule out treatable causes. Neonates with fetal growth retardation (FGR) have an increased incidence of cholestasis. Aim: To determine the prevalence, management, additional healthcare cost and outcome of cholestasis in neonates born with FGR. Methods: Retrospective review of all neonates admitted to the NICU at Valley Children’s Hospital, from January 1, 2021 to December 31, 2022 was done. Data of the infants with FGR was collected. Results: Of 2850 infants admitted in the 2-year period, 42 had a birth weight of less than 10th percentile, of which 19 developed cholestasis (45%). 12 of the 19 infants were preterm infants and 7 were term infants. Average gestational age at birth was 31.6 and average direct bilirubin of 5.2 mg/dL. The average length of stay was 54 days Of the 19 infants who developed NC, 8 were discharged on ursodiol and followed up in gastroenterology clinic. 17 showed resolution of NC within 6 months of discharge. Some infants underwent extensive work-up. Costs for the work-up added up to an average of $8,920. Conclusion: Prognosis for NC in the FGR neonates appears to be good with resolution in our study population within the first year of life. Hence, it may be safe to monitor these neonates with outpatient followup with early limited evaluation until complete resolution of cholestasis.