Histopathological Changes of Hepatobiliary Dysfunction in Fatal Neonatal Sepsis

Background: Neonatal septicemia is a leading cause of neonatal mortality.While sepsis-induced hepatobiliary dysfunction is recognized clinically, histopathological changes observed in postmortem liver biopsies of neonates with fatal sepsis have been infrequently documented.Methodology: All neonates with sepsis, found to be positive on blood culture, in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital were included during the period March-November 2006.Those with major congenital malformation were excluded.In all cases liver function tests were performed on 3 rd and 10 th day.A percutaneous liver biopsy (postmortem) was done using a trucut biopsy needle, for all deaths.The biopsy specimen was immediately stored in formalin and underwent histopathological examination.Results: A total of 153 neonates with culture-positive sepsis were included, with a mean (SD) age of 3.18 (1.38) days.More than two thirds of these were low birth weight.Klebsiella pneumoniae (96%) was isolated in majority.Nearly half (54%) of the patients had biochemical evidence of hepatobiliary dysfunction.Post-mortem liver biopsy was reported in 67 out of 76 deaths.The most common abnormality reported was Kupffer cell hyperplasia (n=41, 61.2%) followed by microvesicular steatosis (n=30, 45%), inflammatory cells in portal area (n=22, 32%), diffuse extramedullary hematopoiesis (n=21, 31%), focal extramedullary haematopoiesis (n=13, 19%), cholestasis (n=7, 10%), necrosis (n=4, 6%) and macrovesicular steatosis (n=2, 3%).Conclusions: Histopathological evidence of hepatobiliary dysfunction in neonates with sepsis is seen in the form of Kupffer cell hyperplasia, steatosis, portal inflammation, cholestasis and necrosis.