Evolução laboratorial da colestase multifatorial em pacientes acompanhados no ambulatório de hepatologia pediátrica do Instituto de Medicina Integral Prof. Fernando Figueira – IMIP

Abstract

Introduction: In the immature liver of the newborn (RN) neonatal cholestasis can occurs in association with one or several risk factors, with no underlying pathology. This condition is called transient multifactorial neonatal cholestasis. Prematurity, intrauterine growth restriction or situations that lead to increased oxidative stress (ischemia, hemodynamic compromise, infections, surgical interventions, food pause, parenteral nutrition and drugs) are related to its genesis. Objective: to evaluate the evolution of neonatal cholestasis in the multifactorial period, as well as to verify the mean changes in liver enzymes, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and canalicular, gammaglutamyltransferase (GGT) and direct bilirubin (BD), comparing the duration of cholestasis of patients who used ursodeoxycholic acid with the time of evolution of those who did not, in order to better characterize this clinical condition and to draw the attention of the health professional about its transient nature, thus avoiding the request for more specific, expensive and, in this case, unnecessary exams. Methods: A cross-sectional study with 32 patients from zero to 90 days who presented with neonatal cholestasis multifactorial, accompanied in the ambulatory of pediatric hepatology of IMIP, from August 2016 to August 2017. Data were collected through medical records. The analysis of the data was performed using software "R" v.3.3.1. Results: The majority of the patients were male (59.38%). The mean age of onset of cholestasis was 35.5 days, and the mean age of onset was 171 days. The mean duration of cholestasis was 135.8 days. The mean BD value of the onset and end of cholestasis was 6.05 and 0.29 mg / dL, respectively. In relation to liver and canalicular enzymes, the mean values of AST, ALT and GGT at baseline were 194.7, 123.8 and 387.9 U / L, and the mean values of 69.1, 56.0 and 121.6U / L, respectively. Only 11 patients used ursodeoxycholic acid (UDCA). The mean duration of cholestasis in this group was 114.1 days. Those who did not use the UDCA, 21 patients, presented cholestatic jaundice for a mean time of 147.1 days. Conclusion: In view of the results obtained with the retrospective analysis of patients with a diagnosis of multifactorial cholestasis, the transient and benign nature of this clinical condition is noted, with a mean duration of cholestasis around 136 days of life and an important decrease in liver enzyme levels after resolution of the frame.