Neonatal Hepatitis is a medical condition of inflammation of the liver in infancy. Neonatal hepatitis is often caused by a viral infection. Infection occurs before birth or after birth. The infant is infected during pregnancy in uterus or after delivery. In this article, we will discuss in detail about various causes, symptoms, and treatments for Neonatal Hepatitis.
How Is Neonatal Hepatitis Defined?
- Inflammation- Neonatal hepatitis is a medical condition of inflammation of liver during infancy.
- Symptoms After Birth- Symptoms are often observed during 1 to 3 months after birth.
- Intrauterine Infection- Studies show that about 20% of infants are infected before the birth in uterus.
- Known Viral Infection-Following viral Infection has been detected in 20% of cases causing Neonatal Hepatitis-
- Cytomegalovirus
- Rubella
- Hepatitis A, B and C.
- Unknown Viral Infection- Viral infection is not detected in remaining 80% of the cases.
- Jaundice- The reason for development of Jaundice is obstruction of bile flow as a result of an inflammation or obstruction of bile duct.
- Hepatosplenomegaly- Apart from this, the child may also have enlarged liver and spleen.
Causes of Neonatal Hepatitis
- Known Viral Infection1–
- Cytomegalovirus
- Measles Virus
- Hepatitis A, B and C Virus.
- Unknown Viral Infection-
- 80% of the neonatal hepatitis is caused by unknown viral infection.
Symptoms Of Neonatal Hepatitis
- Jaundice- Skin and eye appears yellowish at 2 to 3 months age.
- Urine Discoloration- Urine looks yellowish.
- Hepatomegaly- Liver enlargement.
- Splenomegaly- Enlarged spleen.
- Growth-
- Height growth is restricted
- Low weight
- Cirrhosis of Liver-
- Encephalopathy- Jaundice and higher bilirubin concentration in blood causes cerebral edema resulting in symptoms of confusion and coma.
- Esophageal Varices- Bleeding esophagus.
- Ascites- Abdominal collection of fluid.
- Pleural Effusion- Short of breath.
Diagnosis for Neonatal Hepatitis
Blood Examination for Neonatal Hepatitis
Complete Blood Count-
- Low hemoglobin
- Low white blood cell count
- Liver function test:
- Bilirubin- elevated
- Liver Enzyme- SGOT and SGPT elevated
Serology Studies-
- Investigate antibodies
- Look for bacterial and viral bodies
- Viral hepatitis,
- Toxoplasmosis and
- Cytomegalovirus.
Urine Examination for Neonatal Hepatitis
- Urobilinogen- Elevated
- Protein- Elevated
- Hemoglobin- Positive in traces
- Bilirubin- Positive
- Ketone- Positive
Liver Biopsy for Neonatal Hepatitis
- Giant Cell Hepatitis- Liver cells 4 to 5 are aggregated to form a giant cell. Group of giant cells are less efficient and functional than normal liver cells.
- Microscopic viral particles are identified
Liver Ultrasound for Neonatal Hepatitis
- Enlarged Liver
Viral and Liver Culture2 for Neonatal Hepatitis
- Viral and liver cell culture is a lab test.
- Sample is placed with cell type.
- Cell types are specific for each virus.
- Growth of virus shows changes in cell type.
Duodenal Tube Test3 for Neonatal Hepatitis
- Rubber tube is passed through nose in to intestine and placed close to bile duct.
- Procedure is performed using endoscope, ultrasound and X-Ray.
- Cholecystokinin is injected intravenously, which causes gallbladder contraction.
- Gallbladder discharges its secretion into intestine.
- Bile is aspirated into tube and collected in a sterile tube.
- Bile is examined in lab.
Treatment For Neonatal Hepatitis
None Specific Treatment For Neonatal Hepatitis:
- Antiviral medication4
- Low fat milk
- Vitamin Supplement- Lack of bile in intestine causes Malabsorption of Vitamin A, D, E and K, which needs to be supplied with the milk.5
- Symptoms of encephalopathy treated with N-acetylcysteine.
- Cirrhosis- Treated with liver transplant
- Prevention-
- Prevent viral infection transmission from mother to infant.6
- Symptomatic Treatment-
- For Fever- Tylenol
- For Seizures- Anti-seizure medication like phenobarbital.
Complications Of Neonatal Hepatitis
- Encephalitis-
- Infants diagnosed with Neonatal Hepatitis that is caused by Rubella or cytomegalovirus become prone to development of infection.
- Encephalitis may result in mental retardation and cerebral palsy.
- Vitamin Deficiency-
- Since infants with Chronic Neonatal Hepatitis are not able to absorb vitamins A, D and K because of absence of bile in intestine.
- Vitamin D Deficiency- Results in a medical condition called as rickets.
- Vitamin A Deficiency- Results in poor growth and vision.
- Vitamin K Deficiency- Results in easy bruising and bleeding.
- Excessive Toxin in Blood- Higher bilirubin and metabolite concentration causes skin irritation.
- Cholestasis of Liver- Cholestasis causes several complications including abnormal vitamin absorption in intestine. Neonatal hepatitis causes 40% of all cholestasis.4
- Cirrhosis of liver.
References:
1. Hepatitis B virus infection.
Chang MH., Semin Fetal Neonatal Med. 2007 Jun;12(3):160-7.
2. Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis.
Benador N1, Mannhardt W, Schranz D, Braegger C, Fanconi S, Hassam S, Talebzadeh V, Cox J, Suter S.
Eur J Pediatr. 1990 May;149(8):555-9.
3. Duodenal tube test in the diagnosis of biliary atresia.
Larrosa-Haro A1, Caro-López AM, Coello-Ramírez P, Zavala-Ocampo J, Vázquez-Camacho G.
J Pediatr Gastroenterol Nutr. 2001 Mar;32(3):311-5.
4. Antiviral therapy in neonatal cholestatic cytomegalovirus hepatitis.
Ozkan TB1, Mistik R, Dikici B, Nazlioglu HO,
BMC Gastroenterol. 2007 Mar 13;7:9.
5. Neonatal jaundice.
Clin Res Hepatol Gastroenterol. 2012 Jun;36(3):253-6. doi: 10.1016/j.clinre.2012.03.018. Epub 2012 May 18.
McKiernan P.
6. Prevention of mother-to-child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium: current standards of care.
Giles ML1, Grace R, Tai A, Michalak K, Walker SP.
Aust N Z J Obstet Gynaecol. 2013 Jun;53(3):231-5. doi: 10.1111/ajo.12061. Epub 2013 Mar 4.
