Bacterial infection: the main cause of acute cholestasis in newborn infants receiving short-term parenteral nutrition.

To test the hypothesis that bacterial infections are the main cause of acute cholestasis in short-term intravenously fed newborns, two groups were studied. Group I consisted of 152 newborn infants who were fed intravenously for at least 7 days and in whom severe bacterial infections developed. Group II was formed of 92 newborn infants who were matched to the group I cases with respect to the year of birth, birth weight and gestational age, Apgar scores, and duration of parenteral nutrition but who did not have infections. Bacterial infections were diagnosed on the basis of impaired microcirculation with prolonged capillary filling time, a shift to the left in the white cell differential, and a positive blood culture. Cholestasis was diagnosed when the total serum bilirubin level was greater than 4 mg/dl and the conjugated fraction made up more than 40% of the total. The results were that all 40 cases of cholestasis were found in the first group of infected infants. All of the other factors were distributed equally between both groups and could not be attributed as a major factor in the etiology of idiopathic neonatal cholestasis. The conclusion was that bacterial infections are the main cause of acute cholestasis in intravenously fed newborn infants.