| dc.description.abstract | Background: Jaundice is a common clinical sign in newborns, especially during the first 2
weeks after birth. Recent global statistics proposed that about 1.1 million babies a year may
possibly develop severe jaundice and a big proportion of them live in sub-Saharan Africa and
South Asia. Only a small proportion will fit into the category of obstructive or "surgical"
jaundice, and only a few of the infants will eventually benefit from surgery. Far too often,
however, the baby with a surgically correctable lesion dies because the damage to the liver
parenchyma is irreversible by the time surgery is performed. The difficult task facing primary
care providers is discriminating between serious conjugated hyperbilirubinemia and benign
unconjugated jaundice because in the early stage, the infants can look very well except for their
jaundice. High-resolution real-time ultrasonography serves as an important tool for
differentiation of obstructive and non-obstructive causes of jaundice in infants and children,
independent of liver function.
Objectives: The objectives of this study were to determine the prevalence of obstructive
jaundice among infants with suspected obstructive jaundice, to describe the clinical presentations
of infants with suspected obstructive jaundice, to describe the hepatobiliary US findings in
infants with suspected obstructive jaundice, and to correlate the hepatobiliary US and clinical
findings in infants with suspected obstructive jaundice in MNRH
Methodology: This was a hospital based cross sectional study. Infants with clinically suspected
obstructive jaundice presenting to Mulago specialized hospital were recruited into the study with
consent of the parents/caretakers. Patients’ demographic data and clinical history were taken and
recorded in a data collection tool. A trans-abdominal hepatobiliary ultrasound scan was
performed on all participants and the findings recorded.
Results:
A total of 74 infants were recruited into the study, and all had an abdominal ultrasound scan
performed with focus on the hepatobiliary system. Out of the 74 infants, 50 were male (67.6%),
and 24 were female (32.4%). The mean age of the participants was 4 months. The majority of the
infants 34(46.0%) had non-obstructive jaundice, and 29(39.2%) of the infants enrolled had
obstructive jaundice. In 11(14.8%) of the infants, the cause of jaundice could not be determined
by ultrasound. Of the patients with obstructive jaundice, the most prevalent US findings were
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those associated with BA and these included the TC sign at 15(20.3%), small/atrophic GB at
16(21.6%), increased hepatic subcapsular flow at 19(25.7%), and increased hepatic artery to
portal vein ratio at 14(18.9%). Twenty eight (96.6%) of the patients with obstructive jaundice
had conjugated bilirubin levels >20% of the total, and 19(65.5%) had a raised serum alkaline
phosphatase.
Conclusion:
More than a third of the infants suspected to have obstructive jaundice actually turn out to have
obstructive jaundice. These typically present with dark urine and acholic stools. Ultrasound scan
is a good imaging modality for distinguishing between obstructive and non-obstructive causes of
jaundice in infants, but there is often need for supplemental imaging in cases where ultrasound is
unable to provide conclusive diagnosis. Thorough clinical assessment with use of the parameters
of percentage of conjugated bilirubin and levels of serum alkaline phosphatase can help to
increase the clinical index of suspicion and ultrasound yield of obstructive jaundice. | en_US |
