Role of Liver Biopsy in the Evaluation of Prolonged Cholestatic Jaundice in Infants at Kenyatta National Hospital

Abstract

Background: Jaundice that lasts beyond 14 days in a term infant and 21 days in a preterm infant is referred to as prolonged jaundice. Cholestatic jaundice is invariably pathologic, so it needs to be quickly diagnosed and treated. A liver biopsy, in conjunction with other clinical methods, is a crucial component during the evaluation of prolonged cholestatic jaundice among infants. Objectives: To determine the role of liver biopsy in the evaluation of prolonged cholestatic jaundice in infants at KNH. Methodology: A retrospective and prospective cross-sectional study conducted at KNH. A data abstraction form and questionnaire were used to collect data. Descriptive and inferential data analysis was done using SPSS version 25. Results: A total of 40 infants were included in the study out of which 57.5% were male. The median age was 2.63 (IQR: 1.20, 4.33) months at admission, 3.00 (IQR: 3.00, 14.00) days at the onset of yellowness of eyes, and 3.30 months (IQR: 1.97, 5.37 months) at liver biopsy. Most of the infants had positive liver biopsy results 38 (95.0%). Of the positive liver biopsy results, two aetiological findings were identified: biliary atresia 22 (57.9%), and neonatal hepatitis 16 (42.1%). The most commonly observed histological features in biliary atresia (BA) were the prominent proliferation of the bile ducts 17 (77.3%) and bile plugging 15 (68.2%). The most frequently encountered histological features in neonatal hepatitis (NH) were giant cell hepatitis 8 (50.0%), ballooning degeneration/ballooning hepatocytes 3 (18.8%), and chronic inflammation around periportal tracts comprising neutrophils and lymphocytes 3 (18.8%). The color of stool (cOR = 4.55 [95% CI: 1.181, 17.524], p = 0.03) and hepatomegaly (cOR = 4.25 [95% CI: 1.087, 16.614], p = 0.04) emerged as significant predictors of biliary atresia. Conclusion: Liver biopsy is a potent investigation with a high diagnostic yield. The common causes of cholestatic jaundice in this study are biliary atresia and neonatal hepatitis. The common histological features that define biliary atresia include prominent proliferation of the bile ducts and bile plugging. Neonatal hepatitis is characterized by histological features such as giant cell hepatitis and ballooning degeneration of hepatocytes