Ultrasonographic studies of gallbladder during neonatal sepsis

ABSTRACT

Neonatal infection is a major cause of morbidity and mortality in neonatal intensive care unit. A few data regarding the gallbladder [GB] manifestations during neonatal infection are known. Is to evaluate the ultrasonographic changes in gallbladder during sepsis, in order to add some markers to the clinical sepsis score. A total of 35 newborn infants with sepsis were examined, the findings were compared to 6 normal neonates. The infection group was further subdivided into two groups according to the intake of enteral feeding. Inclusion criteria included clinical, hematological and bacterial evidence of sepsis. Exclusion criteria included cholestasis due to other causes, perinatal asphyxia, VLBW and congenital anomalies. All cases were subjected to full history taking, physical examination; including estimation of gestational age, Apgar score and managed according to the routine and individual need. Laboratory investigation included; CBC, blood gases and electrolytes, blood glucose, and liver function tests, including total and direct bilirubin. Gallbladder ultrasonographic studies were done after 4 to six hours of fasting then at l5 minutes, 30 minutes. and 90 minutes after feeding to the enteral group. The results of this study showed a significant increase in the mean values of leukocytic count, direct serum bilirubin, P <0.001, there was also significant decrease in the I/T ratio and platelets. There was significant increase in the CRP. Blood cultures were positive among the septic group. There was significant increase in the size of the gall bladder among septic group compared to the normal cases, P<0.001. The enlargement was correlated with the severity of infection, serum bilirubin, gestational age, birth weight and postnatal age among the septic group. There was significant increase in the thickness of the wall of gall bladder of the septic group than the normal infants p<0.01. Sludge was detected in 31.4% of cases, stone was found in two cases. There was one case that showed perforation and biliary peritonitis. Contractility index [CI] was significantly reduced among the septic group than the control group. Cholecystitis was diagnosed among 42.9% of cases. We could demonstrate a significant increase the GB size among the NPO group than the enteral group and significant decrease in the CI. There was no significant difference in the GB wall thickness and CBD size between the enteral and NPO group. Cholecystitis is not uncommon among septic newborn infants. A target therapy to cholestasis, cholecystitis among septic newborn is highly recommended. Cholecystitis should not be overlooked when evaluating newborn infant with septicemia