Prevalence and Outcome of Hepatobiliary Dysfunction in Neonatal Septicaemia

Abstract

Hepatobiliary dysfunction is common in Gram-negative neonatal septicaemia. The onset of abnormalities is early in most cases but ultimately resolve within 2 to 3 months after sepsis. The presence of conjugated hyperbilirubinemia in neonatal sepsis may carry a better prognosis in terms of survival and has no significant effect on growth during early infancy.

Conjugated hyperbilirubinemia in the neonatal intensive care unit

“…Liver damage may also occur as a consequence of hypotension or prolonged hypoxia in the course of sepsis if cardio-circulatory failure develops (29). CH is more commonly associated with Gram-negative bacteremia (15)(16)(17), however it can occur in case of Gram-positive bacteremia or nonbacterial infection as well (29). Our series also showed that sepsis-induced cholestasis was associated with dominantly Gram-negative agents.…”

“…Our series also showed that sepsis-induced cholestasis was associated with dominantly Gram-negative agents. Like observed in our cases, cholestasis usually subsides slowly after resolution of the infection (15)(16)(17)29).…”

“…The first was characterized with cardiovascular failure, which was resulted from variety of disorders including asphyxia, shock and heart defects. Several previous studies have also identified these entities as an important causal factor in hepatic dysfunction (10,(12)(13)(14)(15)(16)(17)(18)25,26). Such dysfunction may be explained by the theory of hepatic cell integrity and bile secretion processes which are impaired by hepatic hypoxia-ischemia (10).…”

“…Sepsis is a well-known cause of neonatal cholestasis (1,(15)(16)(17)29). It is considered that proinflammatory cytokines play a key role in the pathophysiology (1), and hepatocellular dysfunction has been demonstrated to occur early after the onset of sepsis (29).…”

“…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.…”