What diagnosis should be considered for a neonate with poor feeding, emesis, and acholic stools in the absence of infectious causes?

The symptoms of poor feeding, emesis (vomiting), and acholic stools (pale, clay-colored stools) in a neonate strongly suggest a problem with bile flow or liver function. Among the given options, the most appropriate diagnosis to consider is biliary atresia.

Biliary atresia is a condition in newborns in which the bile ducts are absent or blocked, preventing bile from reaching the intestine. This leads to a buildup of bile in the liver, resulting in liver damage and the characteristic acholic stools due to the lack of bilirubin reaching the intestines to color the stool. Poor feeding and vomiting can result from the overall illness and the lack of normal digestion due to bile obstruction.

While idiopathic neonatal hepatitis is a possibility, it typically presents later and is often associated with hepatic dysfunction or different clinical signs. In this scenario, biliary atresia is much more characteristic given the specific combination of symptoms: especially the acholic stools, which align directly with lacking bile due to obstruction.

In summary, biliary atresia should be considered for this cluster of symptoms, as it directly correlates with the presentation of acholic stools and significant feeding difficulties in a neonate.