Affiliations: Department of Pediatrics, Division of Neonatology,
School of Medicine, State University of New York at Stony Brook, Stony Brook,
NY, USA | Department of Pediatrics, Division of Neonatology,
Tripler Army Medical Center, Pacific Regional Medical Command, Honolulu, HI,
USA | Department of Preventive Medicine, Division of
Biostatistics, School of Medicine, State University of New York at Stony Brook,
Stony Brook, NY, USA
Note: [] Correspondence: Shetal Shah, MD, Division of Neonatal Medicine,
Department of Neonatology, Stony Brook University School of Medicine, Stony
Brook, NY 11791, USA. Tel.: +1 631 444 7563; Fax: +1 631 444 9142; E-mail:
shetal.shah@stonybrook.edu
Abstract: Neonatal hepatic abscess is a rare, but serious complication of
umbilical line catheterization, conferring a high level of mortality. Given the
infrequency of this condition, no evidenced-based data exists on treatment. To
assess factors correlated with increased survival of published cases of
neonatal hepatic abscess and discern implications for treatment. A systematic
search of PubMed, MEDLINE, LEXIS-NEXIS Academic Universe, Biological Abstracts,
BioMed Central and the Institute for Scientific Improvement's Web of Knowledge
and Web of Science bibliographies was performed to identify reports, case
reviews and studies of neonatal hepatic abscess. Post-surgical incidences of
hepatic abscess were excluded. A dataset of cases, which met inclusion
criteria, was constructed including year of publication, cultured organisms in
abscess, treatment (antibiotics or antibiotics plus surgical drainage),
gestational age and outcome. Fisher's exact test in bivariate analysis and
multivariate logistic regression were performed to identify factors associated
with survival. From 1967 to 2007, 41 cases of non-surgical neonatal hepatic
abscess were identified with an overall mortality of 58.5%. A sharp decline
in mortality (82.6% to 27.8%) after 1990 was noted. Use of vancomycin,
single infectious organism and use of surgical drainage in conjunction with
antibiotics were associated with survival in bivariate analysis. Using logistic
regression, Gram-negative infection was associated with increased mortality and
the use of vancomycin showed a trend toward improved survival. Neonatal hepatic
abscess is a rare, highly lethal condition. Increased morbidity is seen in
patients with Gram-negative infection. Based on the statistical review of
published cases, use of vancomycin (regardless of organism) and use of surgical
drainage in the treatment regimen may improve survival.
Keywords: Hepatic abscess, neonatal intensive care
