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首页> 外文期刊>Journal of pediatric gastroenterology and nutrition >Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition
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Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

机译：婴幼儿胆汁性黄疸评价指南：北美儿科胃肠学，肝脏学和营养和欧洲儿科胃肠病学，肝脏学和营养学会的联合建议

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Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (25%-40%) followed by an expanding list of monogenic disorders (25%), along with many unknown or multifactorial (eg, parenteral nutrition-related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature and the combined experience of the authors. The committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dL or >17 mu mol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modem broad-based next-generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including biliary atresia, leading to improved outcomes.
机译：婴儿期的胆汁淤积性黄疸会影响每2500名婴儿的大约1个，并且在生理黄疸的环境中，主要提供者不经常认可。胆汁淤积性黄疸始终是病理的，并表明肝胆功能障碍。初级保健医生的早期检测和对儿科胃肠病学家/肝病学家的及时转诊是最佳治疗和预后的重要贡献者。胆汁滋生滋鸡在生命的第一个月中最常见的原因是胆道休息（25％-40％），然后是单一的单一疾病（25％）列表，以及许多未知或多术（例如，肠胃外营养相关）原因，每个可能具有时间敏感和不同的治疗计划。因此，这些指南可以对评估新生儿胆汁淤积来优化护理的重要作用。本临床实践指南的建议是基于对发表文献的审查和分析以及作者的综合经验。委员会建议任何婴儿在2周龄的年龄后如何在2周后得到华​​而不实的胆汁淤积，其测量血清胆红素的测量，血清直接胆红素水平升高（直接胆红素水平> 1.0mg / dl或>17μmol / l）保证及时审议评估和转诊给儿科胃肠病学家或肝病学家。值得注意的是，当前的差分诊断计划现在在适当的临床背景下纳入了考虑的基于MODEM广泛的下一代DNA测序技术。这些建议是一般指导方针，并不旨在作为临床判决的替代品或作为胆汁淤积的所有婴儿的议定书。预计这些建议的广泛实施将减少诊断儿科肝病，包括胆道休息室的时间，导致改善结果。

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