Factors associated with cholestasis after surgery for congenital duodenal atresia
Keywords:Duodenal atresia, Postoperative, Cholestasis, Trans-anastomotic tube
Background: This study assessed the characteristics of neonates with duodenal atresia (DA) who developed transient postoperative cholestasis which resolved spontaneously, without identifiable congenital anomalies or surgical complications, and identified potential risk factors for cholestasis.
Methods: Neonates with DA who underwent surgery at our institution between January 2009 and July 2022 were retrospectively reviewed. Demographic factors, intraoperative findings, placement of a trans-anastomotic tube (TAT), and postoperative outcomes were compared between patients who developed cholestasis (conjugated hyperbilirubinemia >2.0 mg/dL) after surgery (Group A) and those who did not (Group B). This report is a retrospective cohort study and complies with the STROBE statement.
Results: Among 19 neonates with DA, 6 (31.6%) developed cholestasis after surgery, with the highest direct bilirubin value being 4.3 (2.4-6.5) mg/dL (median, [range]) on postoperative day 14.5 (2-23) that persisted for 67 (47-116) days until spontaneous resolution. Neonates in Group A had a significantly younger gestational age (36.6 vs. 38.0 weeks) (median) (p=0.038), a higher rate of Down syndrome (66.7 vs. 15.4%) (p=0.046), a higher rate of TAT placement (66.7 vs. 15.4%) (p=0.046), and longer administration of total parenteral nutrition (15.5 vs. 7.0 days) (p=0.027) than those in Group B.
Conclusion: Transient cholestasis after surgery for DA seemed to be associated with prematurity, Down syndrome, parenteral nutrition, and TAT placement.
Reid IS. Biliary tract abnormalities associated with duodenal atresia. Arch Dis Child. 1973; 48:952-7. https://doi.org/10.1136/adc.48.12.952
Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg. 1993; 17:301–9. https://doi.org/10.1007/BF01658696
Mali V, Wagener S, Sharif K, Millar AJ. Foregut atresias and bile duct anomalies: rare, infrequent, or common? Pediatr Surg Int. 2007; 889–95. Available from: https://doi.org/10.1007/s00383-007-1921-y
Aspirot A, Su W, Flageole H, Puligandla PS, Shaw K, Laberge JM. Cholestasis associated with small bowel atresia: do we always need to investigate? J Pediatr Surg. 2007; 42:873–7. https://doi.org/10.1016/j.jpedsurg.2006.12.053
Toyama C, Masahata K, Ibuka S, Nara K, Soh H, Usui N. The risk factors for cholestasis in patients with duodenal atresia in a single institutional cohort. Pediatr Surg Int. 2021; 37:929–35. Available from: https://doi.org/10.1007/s00383-021-04890-6.
Deguchi K, Tazuke Y, Matsuura R, Nomura M, Yama-naka H, Soh H, et al. Factors associated with adverse outcomes following duodenal atresia surgery in neonates: A retrospective study. Cureus. 2022; 14; e22349. https://doi.org/10.7759/cureus.22349
Champion V, Carbajal R, Lozar J, Girard I, Mitanchez D. Risk factors for developing transient neonatal cholestasis. J Pediatr Gastroenterol Nutr. 2012; 55:592–8. https://doi.org/10.1097/MPG.0b013e3182616916
Ling DXH, Bolisetty S, Krishnan U. Cholestatic jaundice in neonates: How common is biliary atresia? Experience at an Australian tertiary center. J Paediatr Child Health. 2021; 57:87-95. Available from: https://doi.org/10.1111/jpc.15131
Tufano M, Nicastro E, Giliberti P, Veggente A, Raimondi F, Iorio R. Cholestasis in neonatal intensive care unit: incidence, aetiology and management. Acta Paediatr. 2009; 98:1756–61. https://doi.org/10.1111/j.1651-2227.2009.01464.x.
Ravel A, Mircher C, Rebillat AS, Cieuta-Walti C, Meg-arbane A. Feeding problems and gastrointestinal diseases in Down syndrome. Arch Pediatr. 2020; 27:53–60. https://doi.org/10.1016/j.arcped.2019.11.008
Cresner R, Neville JJ, Drewett M, Hall N J, Darwish AA. Use of trans-anastomotic tubes in congenital duodenal obstruction. J Pediatr Surg. 2022; 57:45–8. https://doi.org/10.1016/j.jpedsurg.2022.01.049
Bethell GS, Long AM, Knight M, Hall NJ, BAPS-CASS. Congenital duodenal obstruction in the UK: a population-based study. Arch Dis Child Fetal Neonatal Ed. 2020; 105:178–83. Available from: http://dx.doi.org/10.1136/archdischild-2019-317085
Hile GB, Musick KL, Dugan AJ, Bailey AM, Howington GT. Occurrence of hyperbilirubinemia in neonates given a short-term course of ceftriaxone versus cefotaxime for sepsis. J Pediatr Pharmacol Ther. 2021; 26:99-103. https://doi.org/10.5863/1551-6776-26.1.99
How to Cite
Copyright (c) 2023 Yosuke Minami, Takiguchi Kazuaki, Hirofumi Shimizu, Hideaki Tanaka
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.