Abstract
Objective
This study aimed to evaluate the frequency of biliary sludge, the presence of defined risk factors, and the clinical course in infants followed in the neonatal intensive care unit (NICU).
Methods
This retrospective, cross-sectional study included all infants hospitalized in two separate tertiary NICU and who underwent routine abdominal ultrasonography screening between July 2023 and July 2024. Ultrasonographic findings of the gallbladder were classified as those with normal gallbladder content, isolated biliary sludge, and microlithiasis accompanying biliary sludge.
Results
Bile sludge was detected in 23 of 552 infants included in the study, and the frequency of bile sludge was 4.16%. The mean birth weight of infants was 2174±629 g, and the mean gestational age was 34.3±2.6 weeks. Bile sludge was more common among male infants with 69.5%. Neonatal sepsis was significantly more common in infants with isolated bile sludge, and intrauterine growth retardation was significantly more common in infants with microlithiasis. Spontaneous resolution of biliary sludge and microlithiasis was observed in all cases.
Conclusion
There is limited information about biliary sludge in newborns and children. In our study, it was shown for the first time in the literature that the frequency of biliary sludge is higher than the general population and is common among male infants in a large series of NICU patients. When the natural course of biliary sludge is observed, it is shown to be a dynamic condition that is not associated with the need for treatment or complications.
Keywords: Biliary sludge, gallstones, neonatal intensive care
References
Goldstein I, Tamir A, Weisman A, Jakobi P, Copel JA. Growth of the fetal gall bladder in normal pregnancies. Ultrasound Obstet Gynecol. 1994;4:289-93.
Chan L, Rao BK, Jiang Y, Endicott B, Wapner RJ, Reece EA. Fetal gallbladder growth and development during gestation. J Ultrasound Med. 1995;14:421-5.
Shaffer EA. Gallbladder sludge: what is its clinical significance? Curr Gastroenterol Rep. 2001;3:166-73.
de la Porte PL, Lafont H, Domingo N, et al. Composition and immunofluorescence studies of biliary “sludge” in patients with cholesterol or mixed gallstones. J Hepatol. 2000;33:352-60.
Boitor-Borza D, Rotar IC, Staicu A, Constantin R, Muresan D. Echogenic content in the fetal gallbladder: systematic review of ultrasound features and clinical outcome. Diagnostics (Basel). 2023;13:230.
Shamir SB, Kurian J, Kogan-Liberman D, Taragin BH. Hepatic imaging in neonates and young infants: state of the art. Radiology. 2017;285:763-77.
Pazzi P, Gamberini S, Buldrini P, Gullini S. Biliary sludge: the sluggish gallbladder. Dig Liver Dis. 2003;35 (Suppl 3):39-45.
Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000;31:411-7.
Cuzzolin L, Oggiano AM, Clemente MG, Locci C, Antonucci L, Antonucci R. Ceftriaxone-associated biliary pseudolithiasis in children: do we know enough? Fundam Clin Pharmacol. 2021;35:40-52.
Satar M, Arısoy AE, Çelik İH. Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars. 2018;53(Suppl 1):88-S100.
European Medicines Agency (EMA). Report on the expert meet ing on Neonatal and paediatric sepsis. 2010. Son Erişim Tarihi: 27.03.2025. Erişim Linki: https://www.ema.europa.eu/en/events/expert-meeting-neonatal-paediatric-sepsis
Sepulveda W, Wong AE. Echogenic material in the fetal gallbladder: prevalence, sonographic spectrum, and perinatal outcome in an unselected third-trimester population. J Matern Fetal Neonatal Med. 2020;33:1162-70.
Agnifili A, Verzaro R, Carducci G, et al. Fetal cholelithiasis: a prospective study of incidence, predisposing factors, and ultrasonographic and clinical features. Clin Pediatr (Phila). 1999;38:371-3.
Munjuluri N, Elgharaby N, Acolet D, Kadir RA. Fetal gallstones. Fetal Diagn Ther. 2005;20:241-3.
Petrikovsky B, Klein V, Holsten N. Sludge in fetal gallbladder: natural history and neonatal outcome. Br J Radiol. 1996;69:1017-8.
Cancho Candela R, Díaz González J, Perandones Fernández C, Viñuela Rueda B, Relea Sarabia A, Andrés de Llano JM. Material ecogénico en vesícula biliar fetal: diagnóstico prenatal y seguimiento posnatal [Echogenic material in fetal gallbladder: prenatal diagnosis and postnatal follow-up]. An Pediatr (Barc). 2004;61:326-9.
