Liver enzyme abnormalities in Gram-negative bacteremia of premature infants

Background. Hyperbilirubinemia and liver enzyme abnormalities are commonly observed in sepsis, However, the frequency in premature neonates and the sp ecific relation to Gram-negative bacteria are not known. Patients and methods. Charts of all preterm infants who had positive blood cultures for either Gram-negative bacteria or coagulase-negative staphyloco cci were reviewed. Neonates with Gram-negative bacteremia (n = 54) were com pared with neonates with coagulase-negative staphylococcal bacteremia (n = 31). In addition infants with Gram-negative bacteremia and elevated liver e nzymes (n = 25) were compared with infants with Gram-negative bacteremia an d normal liver enzymes (n = 29), Results. Liver enzyme abnormalities accompanied 46.3% (25 of 54) of Gram-ne gative bacteremia and 12.9% (4 of 31) of episodes of coagulase-negative sta phylococcal bacteremia (P = 0.002). Serum concentrations of liver enzymes w ere significantly higher in infants with Gram-negative bacteremia than in t hose with coagulase-negative staphylococcal bacteremia (P < 0.0001), but no difference in alkaline phosphatase serum values was observed. Infants with Gram-negative bacteremia and elevated liver enzymes were not fed for a lon ger period than infants with Gramnegative bacteremia and normal liver enzym es (7.3 +/- 6.3 days vs. 4.0 +/- 4.3 days, P = 0.03), and this was accompan ied by significant conjugated hyperbilirubinemia (P < 0.0001), Ventilation, total parenteral nutrition and medications were not responsible for the ob served differences. Klebsiella pneumoniae bacteremia was commonly associate d with elevated liver enzymes (12 of 18), whereas none of dhe infants with Pseudomonas aeruginosa bacteremia had elevated liver enzymes, Conclusions, Gram-negative bacteremia is commonly associated with cholestas is in premature neonates. Liver enzyme abnormalities are more common than e levated conjugated bilirubin, not all Gram-negative bacteria have the same effect and the lack of enteral feeding seems to play a more significant rol e than the administration of parenteral nutrition.