Direct hyperbilirubinemia in infants with congenital heart disease

BackgroundThe association between congenital heart disease (CHD) and infantile cholestasis, a key finding for the diagnosis of biliary atresia (BA), has not been previously investigated. The aim of this study was therefore to investigate the characteristics of direct hyperbilirubinemia (D-HB) in infants with CHD. MethodsAll neonates admitted to the present hospital and diagnosed with CHD in 2015 and 2016 were included. D-HB (direct bilirubin2.0mg/dL) at 60days of age and other clinical parameters were retrospectively reviewed. Statistical analysis according to presence of D-HB was performed using chi-squared test or Wilcoxon rank sum test. ResultsSeventy-six patients (M:F, 36:40) were included in this study. CHD consisted of ventricular septal defect in 17, patent ductus arteriosus in 10, and other in 49. Thirteen patients (17.1%) had D-HB at 60days of age. Resolution of D-HB (DB<2.0mg/dL) occurred in 10 of the 13 patients during the hospital stay, and this occurred in 7days in eight of the 10 patients. Sex, gestational age, birthweight, chromosomal anomalies, need for Fontan operation for CHD repair, and/or cardiac operation were not associated with D-HB at 60days of age. ConclusionWhile D-HB was frequently observed in infants with CHD, the majority of D-HB cases resolved spontaneously in 1week. Neonatal clinical parameters or CHD status was not predictive of D-HB. D-HB lasting >1week in infants with CHD should be evaluated for the cause.