Early onset conjugated hyperbilirubinemia in newborn infants

Objectives: To determine the causes and related outcomes of early onset conjugated hyperbilirubinemia in a group of newborn infants, and to determine the incidence of sepsis in these neonates. Methods: The charts of 42 babies with conjugated hyperbilirubinemia were retrospectively reviewed. Results: The mean gestational age was 37 weeks, and the mean postnatal age at presentation was 10 days. Culture-proven sepsis was identified in 15 babies (35.7% of total). Gram-negative bacteria were isolated in 10 cases and E. coli was the most common of these agents (7 cases). Perinatal hypoxia-ischemia was the second most frequent etiology (7 patients; 16.7% of total). The other diagnoses were blood group incompatibility (n=5), Down syndrome (n=3), cholestasis associated with parenteral nutrition (n=3), neonatal hepatitis (n=2), metabolic liver disease (n=1), biliary atresia (n=1), portal venous thrombosis (n=1), and unknown (n=4). Thirteen babies with sepsis recovered completely with treatment, whereas the prognosis for those with perinatal hypoxia-ischemia was grave (six of seven died). Conclusions: The findings suggest that early onset cholestatic jaundice in newborn infants is more commonly from nonhepatic causes, so it is reasonable to monitor these infants carefully for a period of time before undertaking time-consuming or invasive investigations towards a primary liver disease.