Document Detail


Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome?
MedLine Citation:
PMID:  15231944     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Enrico Zecca; Simonetta Costa; Valeria Lauriola; Giovanni Vento; Patrizia Papacci; Costantino Romagnoli
Related Documents :
7745514 - One-year follow-up evaluation of 260 premature infants with respiratory distress syndro...
17906824 - Familial clustering of unexplained transient respiratory distress in 12 newborns from t...
15846674 - Positioning for acute respiratory distress in hospitalised infants and children.
10685034 - Maxillary sinusitis as an indicator of respiratory health in past populations.
16726604 - In vitro exposure of ovine ova to (brucella abortus ).
14605504 - Stereoselective analysis of 2-hydroxysebacic acid in urine of patients with zellweger s...
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    
Affiliation:
Division of Neonatology, Catholic University of the Sacred Heart, Rome, Italy. enrizecca@rm.unicatt.it
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Bile Acids and Salts / adverse effects*
Cholestasis, Intrahepatic*
Female
Humans
Infant, Newborn
Lung / radiography
Male
Pneumonia / etiology*,  radiography
Pregnancy
Pregnancy Complications*
Respiratory Distress Syndrome, Newborn / etiology*
Chemical
Reg. No./Substance:
0/Bile Acids and Salts

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


Previous Document:  Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic ap...
Next Document:  Pseudothrombocytopenia in a preterm neonate.