558 Annals Academy of Medicine Neonatal Hepatic Abscess—NWH Tan et al Neonatal Hepatic Abscess in Preterm Infants: A Rare Entity? NWH Tan, 1 MBBS, MRCPCH (UK), B Sriram, 2 MBBS, MRCP (Paeds) (Lond), APA Tan-Kendrick, 3 BMBCH (Oxon), FRCR (UK), FAMS, VS Rajadurai, 2 MRCP (UK), MD (Paeds), DCH 1 Department of Paediatric Medicine 2 Department of Neonatology KK Women’s and Children’s Hospital, Singapore 3 Private Practice Raffles Hospital, Singapore Address for Reprints: Dr Natalie Tan Woon Hui, Department of Paediatric Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899. Email: nataliewhtan@yahoo.com Abstract Introduction and Objective: Neonatal pyogenic hepatic abscess in preterm infants is a rare entity. We present 6 cases of neonatal liver abscesses diagnosed in our hospital as well as an approach that will facilitate the early diagnosis and management of neonatal pyogenic liver abscess based on our case series and review of the literature. Materials and Methods: Retrospec- tive review of case records of all 6 patients diagnosed with neonatal liver abscess from January 2000 to December 2002 in KK Women’s and Children’s Hospital, Singapore. Results: All neonates were premature with gestational ages between 24 and 34 weeks. Persistence of positive blood culture despite appropriate antibiotic treatment in 67% of the cases prompted use of hepatobiliary ultrasounds to detect liver abscess. Surgical drainage of liver abscess was per- formed in 33% of the cases, with the remainder treated conservatively with appropriate intravenous antibiotics. Half of the infants recovered with resolution of their liver abscess on serial hepatobiliary ultrasound. The other half died of fulminant sepsis. Conclusions: Neonatal pyogenic liver abscess, though rare, is associated with good outcome if diagnosed promptly and appropriate treatment instituted. In a preterm infant with sepsis, a high index of suspicion is required if there is persistence of positive blood culture despite appropriate antibiotic treatment, and hepatobiliary ultrasound should be done to detect and monitor neonatal liver abscess. Ann Acad Med Singapore 2005;34:558-64 Key words: Liver abscess, Outcome, Preterm, Ultrasonography Introduction Liver abscess has been recognised since the time of Hippocrates. The first report on liver abscess was published by Bright in 1836. 1 However, reports pertaining to liver abscess in the neonatal period have been published only since the 1930s. Neonatal liver abscess is a rare entity. To our knowledge, fewer than 100 cases have been reported in the literature. We present 6 additional cases and a review of the current literature pertaining to the latest techniques in diagnosis and management of neonatal liver abscess. Materials and Methods Information on the diagnosis of neonatal liver abscess was obtained from the neonatal intensive care unit and surgical log books in KK Women’s and Children’s Hospital, Singapore from January 2000 to December 2002. There were 6 infants diagnosed with neonatal liver abscess in this period. Their case records were analysed for demographic data, age of diagnosis, possible risk factors, clinical presentation, diagnostic methods, treatment and outcome. Results Table 1 shows the individual characteristics, treatment and outcome of the 6 cases of neonatal liver abscess in our series. Four of the 6 babies (67%) were males. All the neonates were premature, with a median gestational age of 24.5 weeks and birth weight of 743 g. The median age of diagnosis of neonatal liver abscess was 17.5 days. Figures 1 to 3 show the hepatobiliary ultrasound findings of 3 babies. Figure 4 gives an overall outline of the management of all the infants in the case series. Case Series