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Background Topicality. In the modern world in neonatal intensive care units mortality from sepsis remains one of the leading causes of neonatal death. In cases of severe sepsis, the disease occurs with the phenomena of multiple organ failure, and the liver may be involved in the pathological process. The NEOMOD (Neonatal Multiple Organ Dysfunction Score) is used to assess organ dysfunction, including liver. According to this scale, the main criterion for liver damage is an increase in alanine aminotransferase (ALT) activity over 50% of baseline. Also, the enzymatic activity of ALT may be increased in newborns with parenteral nutrition. Objectives The purpose of the study: to study the clinical and laboratory, instrumental and pathomorphological features of septic hepatitis in newborns. Methods An analysis of 32 inpatient maps of children (of which 29 - (90.6%) premature in gestation 27 - 34 weeks) with septic hepatitis. The only diagnostic criterion was considered to be a combination of the above components with systemic inflammatory response syndrome (SIRS - systemic inflammatory response syndrome). Results Hepatomegaly was detected in 25 (78%) patients. Hemorrhagic syndrome was detected in 22 (68.7%) infants, most often in the form of pulmonary or gastrointestinal bleeding. Changes in hemostasis in patients were accompanied by an increase in activated. Splenomegaly was detected in 3 (9.4%) children as a result of hyperplasia of the reticulogistiocytic tissue of the organ in response to sepsis and hepatitis. Conjugated hyperbilirubinemia was detected in all 32 patients (100% of cases). Decreased prothrombin index was observed in 25 children (78%), and increased levels of alanine aminotransferase and aspartate aminotransferase (ALT, AST) in 23 (72%). Hypoproteinemia was observed in 12 children (37.5%). Ultrasound in septic hepatitis in 28 (87.5%) patients was characterized mainly by changes in the liver parenchyma and its vascular system, sometimes in combination with biliary tract lesions in the form of thickening of the gallbladder walls and heterogeneity of its contents. Conclusions Clinical symptoms of septic hepatitis are accompanied by jaundice, in most children hepatomegaly and hemorrhagic syndrome. The main laboratory criteria for septic hepatitis were: conjugated hyperbilirubinemia (100%), decreased prothrombin index (78%) and increased levels of ALT and AST (72%). The most unfavorable prognosis was observed as a result of penetration of the pathogen into the liver through the umbilical vein. In these cases, morphologically formed necrotic hepatitis with total damage to all parts of the hepatobiliary system. The clinical symptoms of the disease were characterized by severe hepatic insufficiency with impaired basic liver function and very high mortality. |
