Sir.—We read with interest the clinical memorandum "Normal Gallbladder Appearing as Abdominal Mass in Neonates" by Liechty et al (Journal 1982; 136:468-469), and we commend the authors on their clinical observations. However, we disagree with their conclusions concerning the pathogenesis of this problem. Virtually, all significantly ill neonates treated in tertiary centers have feedings withheld for hours to days. Therefore, if a lack of enteral feedings was the only or most significant factor in causing gallbladder distention, one would expect a more frequent occurrence of this relatively rare finding.
Including the three cases reported by Liechty et al, there have been ten cases of transient neonatal gallbladder distention reported in the last two years.1-3 Five of these cases were associated with group B streptococcal sepsis.1,3 Three other cases had strong historical and clinical data suggestive of infection,1,3 and the remaining two cases reported by Liechty et