Document Detail

Prevalence and outcome of hepatobiliary dysfunction in neonatal septicaemia.
MedLine Citation:
PMID:  21873892     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cholestatic jaundice and liver enzyme abnormalities have been reported in neonatal septicaemia; the course, pattern, and outcome of such hepatobiliary dysfunction have not been described.
METHODS: One hundred fifty-three neonates with blood culture-positive sepsis were recruited from the neonatal intensive care unit of an urban hospital. Liver function tests were done on day 3 and day 10 in all of the cases. In babies with abnormal results (direct bilirubin >20% of total with a minimum level of 2/dL or alanine aminotransferase [ALT] >50  U/L), tests were repeated weekly for 1 month and then fortnightly for 3 months or until normalization of values. Anthropometry was recorded at all of these visits.
RESULTS: Klebsiella pneumoniae was the commonest organism, isolated in 95.4% of subjects. Eighty-three (54.2%) subjects had hepatobiliary dysfunction in the form of either cholestatic jaundice (n = 65 [42.5%]) or derangement in ALT (n = 57 [37.3%]). The onset of cholestasis was seen by day 3 of sepsis in 80% (n = 52), with maximum value of direct bilirubin seen by the 10th day in 90% (n = 58). Only 15% (n = 10) continued to have cholestatic jaundice beyond 30 days of onset of sepsis, and it resolved by 60 days. Hepatic enzyme abnormalities followed a more protracted course: onset by day 10 in 95%, peak value by day 38 in 90%, and normalisation by 60 days in 82% of subjects. The prevalence of any hepatobiliary dysfunction was found less frequently in babies who died as compared with survivors (43.4% vs 56.7%; P < 0.01). The weight, length, and head circumference during follow-up visits were comparable between neonates with or without hepatobiliary dysfunction.
CONCLUSIONS: 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.
Sumaira Khalil; Dheeraj Shah; M M A Faridi; Ashwani Kumar; Kiran Mishra
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  54     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-23     Completed Date:  2012-09-04     Revised Date:  2013-01-14    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  218-22     Citation Subset:  IM    
Department of Paediatrics, University College of Medical Sciences, University of Delhi and GTB Hospital, Delhi, India.
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MeSH Terms
Alanine Transaminase / blood
Bacteremia / blood,  complications*,  mortality
Biological Markers / blood
Cholestasis / blood,  epidemiology,  microbiology*,  mortality
Follow-Up Studies
Infant, Newborn
Jaundice, Obstructive / blood,  epidemiology,  microbiology*,  mortality
Klebsiella Infections / blood,  complications*,  mortality
Klebsiella pneumoniae / isolation & purification
Liver Function Tests
Prospective Studies
Reg. No./Substance:
0/Biological Markers; EC Transaminase
Comment In:
J Pediatr Gastroenterol Nutr. 2012 Dec;55(6):e153; author reply e153   [PMID:  22986371 ]

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