Nat Rev Gastroenterol Hepatol 16 (8): 497 - 511, 2019. doi: 10.1038 / s41575 - 019 - 0156 - 4 Pathophysiology of Neonatal Cholestasis In cholestasis, the primary failure is of bilirubin excretion, resulting in excess conjugated bilirubin in the bloodstream and decreased bile salts in the gastrointestinal (GI) tract.