TRANSIENT CHOLESTASIS IN NEONATES WITH PERINATAL ASPHYXIA.

Objective: The aim of this study was both to assess the incidence and severity of hepatic involvement in newborns with neonatal asphyxia and to identify factors associated with cholestatic liver disease in this patient group. Methods: Subjects comprised full-term infants (gestational age ³ 36 weeks) with neonatal asphyxia who required treatment and hospitalization at our institution between 2008 and 2013 (ICD-10 codes: P210, P211, and P219). Cholestasis was defined as direct bilirubin levels ³1.5 mg/dL. This study was a retrospective study based on medical records. Results: Cholestasis occurred in 10 of 67 cases (14.9%). Cholestasis was resolved merely by observation in eight of the 10 cases (80%). In these eight cases, the initial Apgar score ranged from 1 to 7 points; age of onset ranged from two to eight days; mechanical ventilation was required in six cases; and intrauterine growth retardation occurred in three cases. Advanced cholestatic liver disease occurred in two of the 10 cases (20%), and these patients required treatment with ursodeoxycholic acid and supplementation of fat-soluble vitamins. In these two cases, the initial Apgar scores were 2 and 6 points, and the onset times were 4 and 6 days after birth. Both patients received mechanical ventilation and experienced central nervous system, renal, and gastrointestinal complications. These patients also had persistent jaundice, and differentiation from extrahepatic etiologies, including biliary atresia and metabolic disease, was required. Conclusion: Cholestasis occurred in about 15% of full-term infants who experienced neonatal asphyxia. Among the infants with post-asphyxial cholestasis, advanced cholestatic liver disease occurred in 3% of patients. These patients required careful observation to differentiate their diagnosis from other liver diseases because post-asphyxial cholestasis is evident several days after birth and becomes persistent. Transient neonatal cholestasis was associated with several contributing factors related to the severity of neonatal distress. [ABSTRACT FROM AUTHOR]