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Referral Patterns and Factors Influencing Age at Admission of Infants with Cholestasis in India

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Abstract

Objectives

To define the recognition, age at admission, referral time and referral pattern of neonatal cholestasis in India.

Methods

This prospective, observational study was conducted from February 2015 through March 2016 in the Pediatric gastroenterology unit of JIPMER, Pondicherry in infants with cholestasis < 6 mo of age.

Results

Among 64 infants, median age of admission was 52 d (IQR 28–63 d). Fifty of sixty four infants (78.1%) came with parent-reported cholestasis-related symptoms of either jaundice alone (57.8%) or bleeding manifestations (20.3%). In 21.9% infants, jaundice was detected by physicians at a median age of 45 d (IQR 38.5–53.2 d). Two infants had intracranial bleed. Only 34% infants with pale stools were identified by the mother. The median healthcare-seeking time was 5.5 d (IQR 2.5–12 d). Among infants presenting to primary healthcare physicians (PHPs) with cholestasis-related symptoms, median time to referral was 5 d (IQR 2.5–12 d). The first point of healthcare contact in 54.7% was a PHP; 17.1% PHPs had reassured the parents. Herbal preparations were prescribed by 14.3%. Only 11.8% of those with jaundice as the only problem were given vitamin K before referral. Biliary atresia (BA) was missed in neonatal intensive care units in 9 cases.

Conclusions

The above issues need to be accounted for before evaluating or implementing screening strategies in India.

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Contributions

GM: Collected the data; BJ: Conceptualized and designed the study, analysed the data and prepared the manuscript. All authors contributed to the manuscript and approved the final manuscript. BJ will act as guarantor for the paper.

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Authors and Affiliations

  1. Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry, 605006, India

    Gopinathan Mathiyazhagan & Barath Jagadisan

Authors
  1. Gopinathan Mathiyazhagan
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  2. Barath Jagadisan
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Corresponding author

Correspondence to Barath Jagadisan.

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Ethical Clearance

The study had been approved by the institute ethic committee that complies with International standards and is registered with the Government of India (JIP/IEC/2014/8/418).

Conflict of Interest

None.

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None.

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Mathiyazhagan, G., Jagadisan, B. Referral Patterns and Factors Influencing Age at Admission of Infants with Cholestasis in India. Indian J Pediatr 84, 591–596 (2017). https://doi.org/10.1007/s12098-017-2342-0

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  • DOI: https://doi.org/10.1007/s12098-017-2342-0

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