Colestase neonatal: Uma abordagem desafiadora para pediatras diante dos principais diagnósticos diferenciais e tratamentos

Renata Dias  Ferreira; Leonardo Rodrigues  Resende

doi:10.33448/rsd-v13i5.45796

Autores

Renata Dias Ferreira Hospital Universitário Maria Aparecida Pedrossian https://orcid.org/0009-0000-1892-578X
Leonardo Rodrigues Resende Hospital Universitário Maria Aparecida Pedrossian https://orcid.org/0000-0002-4325-6255

DOI:

https://doi.org/10.33448/rsd-v13i5.45796

Palavras-chave:

Colestase; Neonatal; Hiperbilirrubinemia; Atresia biliar; Colestase intra-hepática.

Resumo

Os sinais clínicos da colestase neonatal como icterícia, acolia, colúria são facilmente perceptíveis. Porém, cabe ao pediatra a rápida diferenciação da causa da hiperbilirrubinemia colestática devido ao quadro de urgência pediátrica cujo diagnostico tardio pode ser potencialmente grave e letal. Este estudo objetivou identificar as principais causas de icterícia colestática em recém-nascidos e lactentes e como o pediatra pode realizar uma abordagem diagnostica precoce e iniciar tratamento. Por se tratar de um artigo de revisão integrativa propõe auxiliar de forma prática a abordagem dos principais diagnósticos diferenciais da icterícia colestática e terapêuticas disponíveis. As bases bibliográficas pesquisadas: Cocrhane, Embase, Medline e Pubmed. Os critérios de seleção foram artigos gratuitos na integra entre 2019 e 2024, em português, inglês ou espanhol, e presença de ao menos dois dos descritores. Assim, diante de um RN ictérico com mais de duas semanas de vida o pediatra deve solicitar dosagem de bilirrubinas, pois a colestase é sempre patológica com valores da forma direta superiores a 1,0mg/dl e as causas podem ser extra ou intra-hepática com um quadro desafiador de diagnósticos diferenciais. Na extra-hepática temos a atresia biliar cuja abordagem cirúrgica precoce leva a prognostico mais favorável. Por isso na investigação da colestase neonatal o pediatra precisa partir das doenças mais comuns priorizando as com tratamento cirúrgico devido risco de mortalidade. Sendo indispensável à investigação a realização da anamnese do binômio mãe-lactente, exame físico detalhado, avaliação das características das fezes, exames laboratoriais e de imagens, se necessário, biopsia com histopatológico e encaminhamento para especialista.

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Colestase neonatal: Uma abordagem desafiadora para pediatras diante dos principais diagnósticos diferenciais e tratamentos

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