Summary of recommendations and evidence base for strategies to improve outcome of patients with neonatal cholestasis
| RECOMMENDATION | STRATEGY | EVIDENCE |
|---|---|---|
| Test at 2 weeks (fractionated bilirubin levels at 2–3 weeks of age) | Early identification of neonatal cholestasis | Level III: Guidelines from professional organizations (NASPGHAN, CPS, AAP) |
| Application of diagnostic algorithm and early referral to pediatric gastroenterologist | Accurate diagnosis of cause of cholestasis enables early initiation of treatment | Level III: Case series, guidelines from professional organizations (NASPGHAN, CPS, AAP) |
| Immediate intervention to address the underlying condition if cholestasis is identified | Early intervention improves outcomes of biliary atresia, congenital hypothyroidism, galactosemia, tyrosinemia, congenital CMV infection | Level II and III: Retrospective cohort studies, guidelines from professional organizations (NASPGHAN) |
| Further investigation of efficacy and feasibility of screening for neonatal cholestasis | Early identification of neonatal cholestasis results in early intervention | Level II: Prospective cohort studies |
AAP—American Academy of Pediatrics, CMV—cytomegalovirus, CPS—Canadian Paediatric Society, NASPGHAN—North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.