Syeda Sara Batool, Huma Arshad Cheema, Anjum Saeed, Zafar Fayyaz.
Neonatal Cholestasis and Congenital Malaria - Experience from a Tertiary Care Hospital.
Pak Paed J Jan ;44(1):31-5.

Objective: The aim of this study was to observe the frequency of congenital malaria (CM) causing neonatal cholestasis and its clinical presentation. Study design: Retrospective, cross sectional study. Place and duration of study: This study was conducted in the Hepatology unit, The Children`s hospital, Lahore, from December, 2016 to November, 2017. Material and Methods: Only confirmed congenital malaria cases among neonatal cholestasis were recruited and further analyzed. Clinical spectrum of presentation was noted along with detailed examination findings in addition to confirmed diagnosis on peripheral blood smear. Results: Seven (2.34%) children were identified as neonatal cholestasis due to congenital malaria. There were 5 (71.4%) males with median age of 2 months (range 1.5-2.5 months). The pertinent findings of fever, deep jaundice, pallor (Hemoglobin 4.5-7.3 gm/dl) and hepatosplenomegaly with bicytopenia leads to differentials such as sepsis, hemophagocytic syndrome and metabolic disorders. One case had concomitant cytomegalovirus (CMV) positive in addition to CM. All except one underwent bone marrow biopsy with confirmation of plasmodium vivax on peripheral smear. There was no mortality during the study period amongst these children and had excellent clinical improvement on antimalarial with normalization of biochemical parameters except CMV co-infection who went on into liver failure. Conclusion: Congenital malaria causing neonatal cholestasis is a rare condition and should be considered in those with deep jaundice, anemia and hepatosplenomegaly in addition to exclusion of more common causes.

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