Journal
NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY
Volume 16, Issue 6, Pages 346-360Publisher
NATURE PORTFOLIO
DOI: 10.1038/s41575-019-0132-z
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Funding
- US National Institutes of Health (NIH) [U01 DK062453, UL1 TR002535]
- NIH Clinical and Translational Science Award [KL2 TR002534]
- National Center for Advancing Translational Sciences Clinical and Translational Science Award [KL2 TR002534]
- Children's Hospital Colorado Research Scholar Award
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Neonatal cholestasis is a group of rare disorders of impaired bile flow characterized by conjugated hyperbilirubinaemia in the newborn and young infant. Neonatal cholestasis is never physiological but rather is a sign of hepatobiliary and/or metabolic disorders, some of which might be fatal if not identified and treated rapidly. A step-wise timely evaluation is essential to quickly identify those causes amenable to treatment and to offer accurate prognosis. The aetiology of neonatal cholestasis now includes an expanding group of molecularly defined entities with overlapping clinical presentations. In the past two decades, our understanding of the molecular basis of many of these cholestatic diseases has improved markedly. Simultaneous next-generation sequencing for multiple genes and whole-exome or whole-genome sequencing now enable rapid and affordable molecular diagnosis for many of these disorders that cannot be directly diagnosed from standard blood tests or liver biopsy. Unfortunately, despite these advances, the aetiology and optimal therapeutic approach of the most common of these disorders, biliary atresia, remain unclear. The goals of this Review are to discuss the aetiologies, algorithms for evaluation and current and emerging therapeutic options for neonatal cholestasis.
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