Prevalence and Outcome of Hepatobiliary Dysfunction in Neonatal Septicaemia

Prevalence and Outcome of HepatobiliaryDysfunction in Neonatal SepticaemiaSumaira Khalil, Dheeraj Shah, M.M.A. Faridi, Ashwani Kumar, and Kiran Mishra(JPGN 2012;54: 218222)Journal ReadingOleh:Fajar Ahmad PrasetyaFK UNSRI2011BackgroundNeonatal sepsis contributes 25% to neonatal mortality in developing countries. Gram-negative organisms are mainly responsible for sepsis in developing countries and are commonly associated with multiorgan dysfunction, resulting in high mortality and poor outcome

Hepatobiliary dysfunction in the form of cholestatic jaundice and elevated liver enzymes has been reported in more than two-thirds of preterm neonates experiencing Gram-negative septicaemia

contCholestatic jaundice in a neonate may also signify mechanical obstruction of the biliary tract because of biliary atresia or a metabolic disorder.

To plan further investigations towards a primary liver disease and appropriate management, including referral to specialised centres, it is important to distinguish the newborns having cholestatic jaundice because of septicaemia from those having obstructive, hereditary, or metabolic disorders.

The exact course, pattern of abnormalities, and outcome of sepsis associated hepatobiliary dysfunction in neonates have not been described. Problem3ObjectiveThe present study was conducted to determine the prevalence, pattern, and course of hepatobiliary dysfunction in neonatal sepsis, and to evaluate its effect on the survival and growth.Patients and MethodsPatientsOne hundred fifty-three neonates with blood culturepositive sepsis. The data was taken from March 2006 to November 2006 in the University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India.Neonates with major congenital malformation were excluded.Ultrasonography of the abdomen was done in all of the babies to evaluate for any choledochal cyst or extrahepatic biliary atresiacontMethodesThose patients 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 mg/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.ResultsPrevalence of Hepatobiliary Abnormalities

Any hepatobiliary dysfunction (direct bilirubin >20% of total with a minimum level of 2 mg/dL or ALT>50 U/L) was found in 83 (54.2%) subjects.

Cholestatic jaundice was seen in 65 (42.5%) subjects, whereas deranged ALT was seen in 57 (37.3%) cases.

One-fourth (25.4%) of septicaemic babies had cholestatic jaundice as well as derangement of ALT (Table 1).Outcome

OutcomecontOnset, Pattern, and CourseThe onset of cholestasis (n 65) was seen at day 3 of onset of sepsis in 80% (52 of 65) babies. It was present by day 10 in another 15%. Only 150 IU/dL. Total protein