Rose bengal excretion studies as an aid in the differential diagnosis of neonatal jaundice

Experience with radionuclide imaging in 25 infants with neonatal cholestasis and three normal infants is presented in this review. Serial studies were obtained at 15-30, 60-120 min, and at daily intervals until 96 hr after administration of the dose. Some studies were discontinued earlier when evidence of excretion of the radio-dye into the bowel was demonstrated. In 11 infants with intrahepatic cholestasis, due to various etiologies, delayed uptake and excretion by the liver was noted, and evidence of a patent extrahepatic biliary tract was apparent in all by 72 hr. In ten infants with extrahepatic biliary atresia, no evidence of radionuclide excretion was noted during the 96 hr period of observation. Renal excretion of radio-iodinated rose bengal occurred in several of these cases and had to be differentiated from intestinal activity. One of these infants in addition had a proximal bile duct tear and a consequent bile leak which was diagnosed by the serial studies. Four infants suffered from severe intrahepatic cholestasis which could not be differentiated from biliary atresia by the scintigraphic studies. simultaneous 72-hr stool collections in 13 infants were done revealing the correct diagnosis in nine. Two tests had indeterminate results. The errors in the remaining two cases highlighted the technical problems of this method such as constipation and urinary contamination of stool with radioactivity.