신생아에서 패혈증 연관성 담즙정체증의 임상 양상

Abstract

Purpose : Bacterial endotoxins or inflammatory cytokines are known to be important causes of cholestasis in patients with systemic infections such as sepsis. This study was undertaken to investigate the clinical features of cholestasis in newborn infants with sepsis. Methods : This study included 17 neonates with cholestasis diagnosed at the time of septicemia who had no previous history of cholestasis. Cholestasis was defined as a serum level of direct bilirubin greater than 2 mg/dL. Clinical findings such as gestational age, birth weight, onset time of cholestasis, bilirubin level, underlying sepsis and prognosis were evaluated. Results : Sepsis-associated cholestasis developed in 17(14%) of the 121 cases. Sixteen(94%) of 17 patients were premature infants, 15(88%) were on parenteral nutrition (PN) at the time of septicemia, and 2(12%) of them showed hepatic dysfunction. Incidence of sepsis-associated cholestasis was significantly higher in infants with K. pneumoniae sepsis than those with other bacterial or candida sepsis(P<0.05). Sepsis and cholestasis developed at 26±11, 28±11 days of life respectively and the mean total/direct bilirubin level was 5.0/2.7 mg/dL. Two infants who no had PN at the time of septicemia had prolonged starvation and cholestasis of 7 and 15 days, respectively. The mortality rate of the patient group was similar to that of sepsis patients without cholestasis. Conclusion : Sepsis-associated cholestasis in neonates was commonly developed in Gram (－) infection, especially K. pneumoniae. Sepsis should be considered in the causes of cholestasis in neonates, in addition to prolonged starvation and PN.