Sir.—Traynelis and Hrabovsky1 describe gallbladder distention in a 6-day-old preterm infant and state that the treatment is cholecystectomy. They review nine previously reported neonates with distended gallbladder, seven of whom were treated with cholecystectomy or cholecystostomy.
However, we and others2-4 have recently reported small series of newborn infants with distended gallbladders in whom antibiotics and supportive treatment resulted in a good outcome, including resolution of the gallbladder distention. Like the infant reported by Traynelis and Hrabovsky, such infants are premature and have suspected or proved sepsis. It would appear that there usually is no anatomic obstruction of the cystic duct and in most cases surgical intervention is not required.
However, one of the eight neonates with gallbladder enlargement we have seen in the last three years proved to have a necrotic gallbladder as well as necrotizing enterocolitis. Our recommendation is to use broad-spectrum antibiotics and supportive care