Early onset conjugated hyperbilirubinemia in newborn infants

Abstract

The findings suggest that early onset cholestatic jaundice in newborn infants is more commonly from non-hepatic causes, so it is reasonable to monitor these infants carefully for a period of time before undertaking time-consuming or invasive investigations towards a primary liver disease.

Conjugated hyperbilirubinemia in the neonatal intensive care unit

“…The immaturity of hepatobiliary system makes newborn infants relatively more susceptible to a wide variety of disorders (1,21). As seen in the present study, a substantial number of cases are associated with perinatal events which are possibly responsible for chronic or acute perinatal distress (10,15), while others probably have a primary disease of the liver (15,22). The present study was intended to evaluate the underlying causes and outcome of patients with CH in a NICU and to try to understand "What's happening to these cases?".…”

“…However, the etiology of cholestasis in newborns at intensive care settings has a spectrum different from that reported in epidemiological studies (4,6), and is usually on multifactorial basis (7)(8)(9)(10)(11). In this population, common perinatal events such as perinatal hypoxia, parenteral nutrition, sepsis, poor enteral feeding, and cardiovascular collapse can contribute to the development of cholestasis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), in addition to the structurally and functionally immature biliary tract (1,8). Thus, the diagnosis of neonatal cholestasis in this population is one of the most challenging issues.…”

Ursodeoxycholic acid in neonatal sepsis-associated cholestasis

“…3 However, Tiker et al reported a longer onset, on the 10 th day. 15 These differences may be explained by the diversity of sepsis severity in these studies.…”

“…Tiker et al reported that Escherichia coli was the main cause of sepsis (46.6%) among Gramnegative bacteria. 15 However, Bachtiar et al found no association between Gram-negative bacteria and the incidence of cholestasis. 3 Urine bilirubin has been used as a non-invasive screening tool for SAC.…”

“…14 Almost three out of four neonates with SAC had body weight under 2,500 grams, which may be associated with premature birth, similar to a previous report. 15 Sepsis-associated cholestasis occurs mostly in preterm infants and is related to the immaturity of their immune systems. Although SAC is found more frequently among preterm infants, Bachtiar et al reported that gestational age <38 weeks was not a significant risk factor for developing SAC.…”