Which investigation is considered the gold standard for neonatal jaundice?

The investigation that is recognized as the gold standard for evaluating neonatal jaundice is intra-operative cholangiography. This technique is particularly valuable in assessing bile duct obstructions and abnormalities that may lead to conditions such as cholestasis in neonates. During this procedure, contrast is injected into the bile duct system to visualize the anatomy and any potential blockages via X-ray imaging, allowing for a direct assessment.

In contrast, other imaging modalities such as X-ray cholangiography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography, while useful in various contexts, do not offer the same level of direct and immediate evaluation in a neonatal population. For instance, X-ray cholangiography may not provide as detailed a picture and is less frequently performed in neonates due to safety and logistical concerns. Magnetic resonance cholangiopancreatography, though non-invasive and detailed, is not always practical or available for immediate use in neonates. Endoscopic retrograde cholangiopancreatography, while effective for larger subjects with adult presentations, is also not routinely performed in neonates due to the risks associated with endoscopy in this vulnerable group.

Intra-operative cholangiography stands out due to its applicability in real