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Neonatal Jaundice

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Abstract

Hyperbilirubinemia is a common occurrence in neonates; it may be physiological or pathological. Conjugated hyperbilirubinemia may result from medical or surgical causes, and can result in irreversible liver damage if untreated. The aim of imaging is the timely diagnosis of surgical conditions like biliary atresia and choledochal cysts. Abdominal ultrasound is the first line imaging modality, and Magnetic resonance cholangiopancreatography (MRCP) also has a role, especially in pre-operative assessment of choledochal cysts (CDCs). For biliary atresia, the triangular cord sign and gallbladder abnormalities are the two most useful ultrasound features, with a combined sensitivity of 95%. Liver biopsy has an important role in pre-operative evaluation; however, the gold standard for diagnosis of biliary atresia remains an intra-operative cholangiogram. Choledochal cysts are classified into types according to the number, location, extent and morphology of the areas of cystic dilatation. They are often associated with an abnormal pancreaticobiliary junction, which is best assessed on MRCP. Caroli’s disease or type 5 CDC comprises of multiple intrahepatic cysts. CDCs, though benign, require surgery as they may be associated with complications like cholelithiasis, cholangitis and development of malignancy. Severe unconjugated hyperbilirubinemia puts neonates at high risk of developing bilirubin induced brain injury, which may be acute or chronic. Magnetic resonance imaging of the brain is the preferred modality for evaluation, and shows characteristic involvement of the globus pallidi, subthalamic nuclei and cerebellum – in acute cases, these areas show T1 hyperintensity, while chronic cases typically show hyperintensity on T2 weighted images.

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Acknowledgement

The authors acknowledge Dr. Rama Anand and Dr. Suvasini Sharma for help with the images.

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Authors and Affiliations

  1. Department of Radio-Diagnosis, Lady Hardinge Medical College, New Delhi, India

    Pooja Abbey

  2. Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India

    Devasenathipathy Kandasamy & Priyanka Naranje

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  1. Pooja Abbey
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All three authors contributed to the Manuscript preparation and editing. Dr. Rama Anand, Director-Professor and HOD, Department of Radio-Diagnosis, Lady Hardinge Medical College will act as guarantor for this paper.

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Correspondence to Pooja Abbey.

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Abbey, P., Kandasamy, D. & Naranje, P. Neonatal Jaundice. Indian J Pediatr 86, 830–841 (2019). https://doi.org/10.1007/s12098-019-02856-0

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