Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome?

Pediatrics
Enrico ZeccaCostantino Romagnoli

Abstract

We describe 3 cases of neonatal respiratory distress syndrome (RDS) in near-term infants, born from mothers with severe intrahepatic cholestasis of pregnancy. Common pictures of the cases were: good indices of lung maturity in the amniotic fluid; severe RDS requiring mechanical ventilation; high serum bile acid (BA) levels in the early days of life; no meconium aspiration; negative cultures; and absence of indirect laboratory signs of infection. After the first case, we hypothesized that abnormally high BA levels could have reversed the action of phospholipase A2 in the lungs, causing a degradation of phosphatidylcholines to lysophosphatidylcholines and the consequent lack of surfactant activity, leading to the severe respiratory distress. Consequently, in cases 2 and 3, we gave intratracheal surfactant to the infants, which, although administered around the first 24 hours of life, showed to be helpful. Our experience suggests that a high level of attention in the management of newborn infants (even near-term infants) born from women with intrahepatic cholestasis of pregnancy is necessary to detect as soon as possible signs and symptoms of this "unexpected" RDS, which can assume a very severe clinical picture. In such instances...Continue Reading

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Citations

Feb 4, 2010·Current Opinion in Obstetrics & Gynecology·Jonathan K Mays
Oct 17, 2008·Respirology : Official Journal of the Asian Pacific Society of Respirology·Diahn-Warng PerngYu-Chin Lee
May 7, 2009·World Journal of Gastroenterology : WJG·Victoria Geenes, Catherine Williamson
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Feb 4, 2012·Journal of Critical Care·Han-Chen TsaiShi-Chuan Chang
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Aug 26, 2014·Journal of Perinatal Medicine·Patrik SimjákL'uboslav Stárka
May 3, 2006·Pediatrics·Enrico ZeccaCostantino Romagnoli

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