Department of Paediatrics, University College of Medical Sciences, University of Delhi and GTB Hospital, Delhi, India.
J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):218-22. doi: 10.1097/MPG.0b013e318233d33d.
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.
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.
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.
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.
胆汁淤积性黄疸和肝酶异常已在新生儿败血症中报告；但尚未描述这种肝胆功能障碍的病程、模式和结果。
从城市医院新生儿重症监护病房招募了 153 名血培养阳性败血症的新生儿。所有病例均在第 3 天和第 10 天进行肝功能检查。对于结果异常的婴儿（直接胆红素>总胆红素的 20%，最低水平为 2/dL 或丙氨酸氨基转移酶[ALT] >50 U/L），每周重复检查一次，持续 1 个月，然后每两周检查一次，持续 3 个月或直至值正常化。在所有这些就诊时都记录了人体测量数据。
最常见的病原体是肺炎克雷伯菌，在 95.4%的患者中分离到。83 名（54.2%）患者存在肝胆功能障碍，表现为胆汁淤积性黄疸（65 名[42.5%]）或 ALT 异常（57 名[37.3%]）。80%（n=52）的患儿在败血症第 3 天出现胆汁淤积，90%（n=58）的患儿在第 10 天出现直接胆红素的最高值。只有 15%（n=10）的患儿在败血症发病后 30 天以上仍持续出现胆汁淤积性黄疸，并且在 60 天内消退。肝酶异常的发生时间较晚：95%的患儿在第 10 天出现异常，90%的患儿在第 38 天出现峰值，82%的患儿在第 60 天恢复正常。与幸存者相比，死亡患儿的任何肝胆功能障碍发生率均较低（43.4%对 56.7%；P<0.01）。在随访期间，有或没有肝胆功能障碍的新生儿的体重、身长和头围无差异。
革兰氏阴性新生儿败血症中常见肝胆功能障碍。大多数病例的异常发生较早，但最终在败血症后 2 至 3 个月内恢复正常。新生儿败血症中结合胆红素升高可能预示着更好的生存预后，并且在婴儿早期对生长无明显影响。
