Document Detail

Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome?
MedLine Citation:
PMID:  15231944     Owner:  NLM     Status:  MEDLINE    
We describe 3 cases of neonatal respiratory distress syndrome (RDS) in near-term infants, born from mothers with severe intrahepatic cholestasis of pregnancy. Common pictures of the cases were: good indices of lung maturity in the amniotic fluid; severe RDS requiring mechanical ventilation; high serum bile acid (BA) levels in the early days of life; no meconium aspiration; negative cultures; and absence of indirect laboratory signs of infection. After the first case, we hypothesized that abnormally high BA levels could have reversed the action of phospholipase A2 in the lungs, causing a degradation of phosphatidylcholines to lysophosphatidylcholines and the consequent lack of surfactant activity, leading to the severe respiratory distress. Consequently, in cases 2 and 3, we gave intratracheal surfactant to the infants, which, although administered around the first 24 hours of life, showed to be helpful. Our experience suggests that a high level of attention in the management of newborn infants (even near-term infants) born from women with intrahepatic cholestasis of pregnancy is necessary to detect as soon as possible signs and symptoms of this "unexpected" RDS, which can assume a very severe clinical picture. In such instances, we recommend that the diagnosis of BA pneumonia be kept in mind and that exogenous surfactant be given as soon as possible, even in the presence of indices of normal lung maturity in the amniotic fluid. Finding high levels of BA and lysophosphatidylcholines in the bronchoalveolar lavage of affected infants would aid in support of the diagnosis.
Enrico Zecca; Simonetta Costa; Valeria Lauriola; Giovanni Vento; Patrizia Papacci; Costantino Romagnoli
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-02     Completed Date:  2004-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  269-72     Citation Subset:  AIM; IM    
Division of Neonatology, Catholic University of the Sacred Heart, Rome, Italy.
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MeSH Terms
Bile Acids and Salts / adverse effects*
Cholestasis, Intrahepatic*
Infant, Newborn
Lung / radiography
Pneumonia / etiology*,  radiography
Pregnancy Complications*
Respiratory Distress Syndrome, Newborn / etiology*
Reg. No./Substance:
0/Bile Acids and Salts

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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