Clinical

Maternal cholestasis tied to lung injury in neonates

Last Updated: 2008-01-31 15:02:04 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Bile acids are detectable in bronchoalveolar lavage (BAL) fluid of newborns with respiratory distress syndrome (RDS) who are delivered from pregnancies affected by intrahepatic cholestasis, Italian researchers report in the January issue of Pediatrics.

Lead investigator Dr. Enrico Zecca told Reuters Health that "the management of pregnancies complicated by intrahepatic cholestasis should take into account the risk for neonatal RDS, and this implies a close obstetric surveillance to decide the timing of delivery."

Dr. Zecca of the Catholic University of the Sacred Heart in Rome and colleagues prospectively studied 10 such neonates. They were compared with 20 neonates with RDS who were delivered in the absence of intrahepatic cholestasis of pregnancy and a further 20 who had no lung disease and were ventilated for extrapulmonary reasons.

Bile acids were measurable in BAL fluid of the cholestasis group but not in the two control groups. The cholestasis group also had significantly higher serum bile levels than did controls.

These elevated serum levels, say the investigators, "allow us to hypothesize that bile acid reaches the lung after an uptake from the circulation. These findings strongly support a role for bile acid in causing bile acid pneumonia."

Thus, as well as paying close attention to the timing of delivery of these infants, "newborn infants delivered by cholestatic mothers may need surfactant for severe RDS, even though they are full term, because of the occurrence of neonatal bile acid pneumonia," Dr. Zecca concluded.

Pediatrics 2008;121:e146-e149.