Most of the infants (13 of 20) qualifying for the diagnosis of transient neonatal cholestasis had levels of conjugated bilirubin that slightly exceeded the upper normal limit. None of them had acholic stools, and liver function tests were not done routinely. However, none of the results obtained called for further investigations. None of these children had liver biopsy, and none of them developed liver disease. Thus, the population analyzed in the present study may differ not only in the severity of cholestasis from that described by Jacquemin et al, but also in its duration, in the degree of neonatal distress and in comorbidity; we can assume that patients seen at Bicetre (Paris, France) represent those referred with more severe neonatal cholestasis whereas the patients described in the present study represent the patient population of a mother-child centre. Continue reading
Neonatal cholestasis is a condition that demands extensive work-up to exclude inborn errors of metabolism, intrauterine infections, endocrine dysfunction or malformation. Frequently, these investigations do not yield positive findings, and if the cholestasis resolves spontaneously, the condition is called transient neonatal cholestasis. Asphyxiated infants seem to be at risk for this type of transient cholestasis. The present study defines the incidence of transient neonatal cholestasis in asphyxiated infants.
Transient neonatal cholestasis was found in 8.5% of AGA and in 33% of SGA asphyxiated neonates. Cholestatic neonates of both groups were severely affected, as shown by longer periods of mechanical ventilation and a larger number of patients requiring antibiotic therapy and TPN, when compared with asphyxiated newborns without cholestasis. Continue reading
Antibiotic therapy was initiated in 124 of 163 AGA infants (75.6%), in 100% of SGA asphyxiated neonates, and in 100% of infants with cholestasis. Antiepileptics were used in an equal proportion of asphyxiated newborns of each group (six of 18 (33%) SGA, 48 of 163 (29%) AGA and in five of 20 (25%) infants with cholestasis.
All infants required nasogastric tube feeding for enteral nutrition with Similac (Abbot Laboratories, St Laurent, Quebec) or mother’s milk. If oral feeding was not tolerated by day 4, TPN was initiated. TPN was started in 44% (41 of 93) of premature asphyxiated AGA infants, in 8% (seven of 90) of term asphyxiated AGA neonates, and in 14 of 18 (78%) SGA infants, compared with 18 of 20 (90%) infants with cholestasis at diverse moments after birth. Continue reading
Alanine aminotransferase and aspartate aminotransferase were measured in eight of 20 cholestatic infants and normalized in all after the end of total parenteral nutrition (TPN). Bilirubin values were controlled in 13 of 20 cholestatic patients until normalization occured.
Emergency cesarean section was performed in 55.2% of pregnancies with asphyxiated neonates (82 in AGA and 18 in SGA), and in 12 of 20 (60%) children with additional transient neonatal cholestasis.
AGA children were born prematurely in 50.9% (83 of 163) versus 86% (12 of 14) of AGA asphyxiated children with transient neonatal cholestasis. SGA children were born prematurely in 77.3% (17 of 22) versus 83% (five of six) of cases of cholestasis (Table 2). Continue reading
Of a total of 6737 patients admitted to the neonatology department of Sainte-Justine Hospital between 1989 and 1993, and registered in a neonatology database, 256 (3.8%) were classified as asphyxiated, 659 (9.78%) as small neonates for their gestational age (SGA), and 24 (0.36%) as a combination of both. Of all those registered cases, 212 charts of asphyxiated neonates with appropriate weight for their gestational age (AGA) (90 females), and 22 (12 female) charts of SGA neonates were available for study (after exclusion of one with polycystic kidney disease, one with generalized cytomegalovi-ous infection, and one with urea cycle disease). Of the AGA and SGA cases, 49 (20 female) and four (two female), respectively, died within the first 48 h of life. Thus, data were analyzed from a total of 181 (163 AGA and 18 SGA) asphyxiated infants surviving the first 48 h of their life. Continue reading
To select charts for review, a database was used that registered each patient admitted to the neonatology department between 1989 and 1993 as well as definitive diagnoses and complications. Asphyxia was defined by the presence of postanoxic encephalopathy defined by an abnormal Apgar score (a one-minute Apgar score of less than four, a five-minute Apgar score of less than seven, and/or the need for immediate resuscitation or intubation); clinical signs of encephalopathy; and its confirmation by appropriate examinations such as electroencephalogram and brain imaging techniques (echography, computed tomography). Continue reading
Pathological neonatal cholestasis is diagnosed as often as one in 500 newborn infants. It is a nonspecific feature of a liver disorder that occurs with several congenital diseases such as biliary atresia, a1-antitrypsin deficiency and other metabolic, endocrine or perinatal infectious maladies. Newborn infants with transient neonatal cholestasis have recently been described, most of whom suffered from asphyxia and/or prematurity. Continue reading