title: Prevalence and outcome of hepatobiliary dysfunction in neonatal septicaemia.
abstract: 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.
authors.affiliation: Department of Paediatrics, University College of Medical Sciences, University of Delhi and GTB Hospital, Delhi, India.
authors.forename: Sumaira
authors.initials: S
authors.lastname: Khalil
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Shah
authors.forename: M M A
authors.initials: MM
authors.lastname: Faridi
authors.forename: Ashwani
authors.initials: A
authors.lastname: Kumar
authors.forename: Kiran
authors.initials: K
authors.lastname: Mishra
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D016470:Bacteremia / Q000097:blood / Q000150:complications* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D041781:Jaundice, Obstructive / Q000097:blood / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D007710:Klebsiella Infections / Q000097:blood / Q000150:complications* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008111:Liver Function Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase