What are the key clinical signs and symptoms that suggest biliary atresia in a neonate with cholestasis?

Key clinical signs and symptoms suggesting biliary atresia in a neonate presenting with cholestasis include:

• Persistent conjugated hyperbilirubinaemia beyond 2 weeks of age, manifesting as prolonged jaundice with pale or acholic stools and dark urine, is a hallmark feature ¹ (Feldman and Mack, 2015).
• Hepatomegaly may be present on abdominal examination due to liver inflammation and fibrosis ¹ (Orłowska et al., 2017).
• Failure to thrive or poor weight gain can be observed as a consequence of malabsorption related to cholestasis ¹ (Fawaz et al., 2017).
• Absence of improvement or worsening of jaundice despite supportive care is a clinical red flag ¹ (Feldman and Mack, 2015).
• Onset typically within the first 2 months of life, with jaundice persisting beyond the neonatal period, differentiates biliary atresia from physiological jaundice ¹ (Fawaz et al., 2017).

These clinical features, especially pale stools and persistent conjugated hyperbilirubinaemia, should prompt urgent referral for further diagnostic evaluation including liver function tests, imaging, and possibly liver biopsy to confirm biliary atresia ¹ (Orłowska et al., 2017; Feldman and Mack, 2015).