Kolestasis Neonatal di Rumah Sakit Umum Daerah Wangaya, Bali

Abstract

Kolestasis neonatal terjadi akibat kelainan sistem hepatobiliar, sering terlambat didiagnosis karena dianggap fisiologis. Identifikasi dini, menentukan etiologi hingga merujuk ke bagian gastroenterologi-hepatologi anak pada saat yang tepat adalah penting untuk keberhasilan terapi dan prognosis yang optimal. Kasus seorang bayi laki-laki usia 3 minggu dengan keluhan muntah, diare, tubuh kuning, dan tinja kuning pucat. Pada pemeriksaan laboratorium didapatkan hiperbilirubinemia disertai peningkatan kadar bilirubin direk, gama glutamil transferase (GGT), peningkatan hitung leukosit dan trombosit; pemeriksaan tinja menunjukkan infeksi bakteri. Diagnosis kolestasis berdasarkan peningkatan bilirubin direk >20% kadar bilirubin total, mengarah pada tipe intrahepatal berdasarkan peningkatan GGT <10 kali lipat batas atas normal. Pasien mendapat terapi antibiotik, disertai terapi suportif stimulasi aliran empedu dan vitamin larut lemak.   Neonatal cholestasis is caused by the abnormality of the hepatobiliary system, often unrecognized and late-diagnosed because of misinterpretation as physiological jaundice. Early identification of the underlying etiology and timely referral to pediatric gastroenterology and hepatology are important for successful treatment and optimal prognosis. We reported a male infant age 3 weeks with vomiting, diarrhea, icterus, and pale stool. Laboratory findings were hyperbilirubinemia with high direct bilirubin, gamma-glutamyl-transferase (GGT), elevated leukocyte and thrombocytes, and stool test indicated bacterial infection. Diagnosis of cholestasis is based on high direct bilirubin >20% total bilirubin, with intrahepatic type based on elevated GGT <10 times from the upper limit. The patient was treated with antibiotics and supportive treatment of bile flow stimulant and fat-soluble vitamin.