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Neonatal Hepatitis


Presentation

  • Other features of Alagille's syndrome were not present; other conditions frequently associated with interlobular bile duct paucity were also excluded. Subsequently, the infant was found to have cystic fibrosis.[ncbi.nlm.nih.gov]
  • In contrast with physiologic neonatal jaundice, infants with neonatal hepatitis present with dark urine. Infants may also present with delayed growth. [1] Causes [ edit ] The cases of neonatal hepatitis are many.[en.wikipedia.org]
Prolonged Bleeding
  • On the fourth day, he developed petechiae and bruises over his chest wall and extremities, and prolonged bleeding was observed over venipuncture sites.[ncbi.nlm.nih.gov]
  • In more serious forms of neonatal hepatitis additional symptoms can occur including easy bruising, prolonged bleeding, infection (sepsis) and/or the accumulation of body fluids within the abdomen (ascites) in the later stages of chronic liver injury.[rarediseases.org]
Intravenous Administration
  • Prolonged cholestasis has improved immediately upon intravenous administration of a high-dose gammaglobulin treatment in all three patients.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Serial chest radiographs showed bilateral pleural effusions, and an ultrasound of the abdomen demonstrated ascites. An echocardiogram showed normal cardiac structure and good contractility of both ventricles.[ncbi.nlm.nih.gov]
  • Pleural Effusion- Short of breath.[epainassist.com]
Respiratory Distress
  • On the contrary, NH can be more fatal with associated disorders such as growth retardation, specific infections, respiratory distress, and metabolic or endocrine diseases.[ncbi.nlm.nih.gov]
Clay-Colored Stool
  • The younger brother developed jaundice and clay-colored stools at the age of 1 month. The diagnosis of extrahepatic biliary atresia was made at laparotomy at the age of 4 1/2 months.[ncbi.nlm.nih.gov]
  • Symptomatic infection causes jaundice, lethargy, failure to thrive, abdominal distention, and clay-colored stools. Diagnosis is by serology. Rarely, severe illness may cause acute liver failure requiring liver transplantation.[msdmanuals.com]
Failure to Thrive
  • Symptomatic infection causes jaundice, lethargy, failure to thrive, abdominal distention, and clay-colored stools. Diagnosis is by serology. Rarely, severe illness may cause acute liver failure requiring liver transplantation.[msdmanuals.com]
  • By the age of 2 to 3 months, it becomes clear that an infant with neonatal hepatitis is not gaining weight and is growing at a slower than normal rate (failure to thrive). The infant may be irritable because of excessively itchy skin (pruritus).[rarediseases.org]
  • It is important to note that infants with biliary atresia might not necessarily present with typical symptoms of failure to thrive or ascites, 15 and the primary care physician must be suspicious of cholestasis in all cases of prolonged jaundice.[cfp.ca]
Abdominal Mass
  • At 28 months a laparotomy was performed because of continuing jaundice and the development of an abdominal mass. Biopsy of the mass revealed a hepatocellular carcinoma.[ncbi.nlm.nih.gov]
Jaundice
  • The observations on the critical evaluation of the neonatal jaundice cases led us to propose AIIMS clinical score (ACS) and this retrospective study was designed to evaluate the reliability of the ACS in all the 120 babies with jaundice referred to the[ncbi.nlm.nih.gov]
  • Infants with this condition are usually jaundiced. Jaundice that is caused by neonatal hepatitis is not the same as physiologic neonatal jaundice.[en.wikipedia.org]
Hepatomegaly
  • The hepatitis group had the highest frequencies of high-grade hepatomegaly and splenomegaly. Fifty six cases completely recovered. Two died of hepatic failure in early infancy and four had chronic liver diseases at the age of 12 months.[ncbi.nlm.nih.gov]
  • There was jaundice and hepatomegaly. Others systems were normal.[pediatriconcall.com]
  • […] idiopathic • By mid-2000s, idiopathic neonatal hepatitis (INH) comprised only 15-30% of neonatal cholestasis due to increased ability to detect and diagnose metabolic and genetic disorders previously considered idiopathic Clinical Issues • Jaundice • Hepatomegaly[basicmedicalkey.com]
  • The common symptoms include jaundice (yellow discoloration of the skin and the whites of the eyes) and hepatomegaly (liver enlargement). There are many reasons that can result in hepatitis.[biology-online.org]
Neonatal Jaundice
  • Jaundice that is caused by neonatal hepatitis is not the same as physiologic neonatal jaundice. In contrast with physiologic neonatal jaundice, infants with neonatal hepatitis present with dark urine.[en.wikipedia.org]
  • The observations on the critical evaluation of the neonatal jaundice cases led us to propose AIIMS clinical score (ACS) and this retrospective study was designed to evaluate the reliability of the ACS in all the 120 babies with jaundice referred to the[ncbi.nlm.nih.gov]
  • The detection of Au-Ag in prolonged neonatal jaundice with direct bilirubinemia favors a diagnosis of hepatitis type B, which in our experience carries a graver prognosis reflected in deaths and cirrhosis when compared to neonatal hepatitis not associated[pediatrics.aappublications.org]
Scleral Icterus
  • At 30 hours of life, the infant was noted to have scleral icterus. Total and direct bilirubin was 26.6 and 15.1 mg/dl, respectively, and on repeat were 25.5 and 14.5 mg/dl.[nature.com]
  • CLINICAL PRESENTATIONCLINICAL PRESENTATION Jaundice Scleral icterus Hepatomegaly Acholic stools Dark urine Other signs and symptoms depend on specific disease process 18.[slideshare.net]
Liver Dysfunction
  • Neonatal hepatitis refers to many forms of liver dysfunction that affects fetuses and neonates. [1] It is most often caused by viruses or metabolic diseases, and many cases are of an unknown cause. [2] Signs and symptoms [ edit ] The infant with neonatal[en.wikipedia.org]
  • If no specific cause of liver dysfunction is identified, neonatal hepatitis is the term used to describe the inflammatory process happening in the infant’s liver.[liver.ca]

Workup

  • We established a 3-day workup protocol for the differential diagnosis of biliary atresia and neonatal hepatitis and compared the diagnostic accuracy, sensitivity, specificity, and predictive values of various methods.[ncbi.nlm.nih.gov]
  • Some children may require a liver biopsy as part of their diagnostic workup. If no specific cause of liver dysfunction is identified, neonatal hepatitis is the term used to describe the inflammatory process happening in the infant’s liver.[liver.ca]
Liver Function Tests Abnormal
  • Abstract A male infant presenting with neonatal hepatitis syndrome, characterized by conjugated hyperbilirubinemia and very mild liver function test abnormalities, at 2 weeks of age was found to have no excretion of radioisotope into the intestinal tract[ncbi.nlm.nih.gov]
C-Reactive Protein Increased
Chlamydia
  • The mother was RPR-negative, hepatitis B surface antigen-negative, HIV-negative, chlamydia-negative, gonorrhea-negative, and rubella-immune. During pregnancy, the mother had two gynecological cytology exams, both within normal limits.[nature.com]
Trophoblastic Cells
  • Transferrin receptor co-localizes and interacts with the hemochromatosis factor (HFE) and the divalent metal transporter-1 (DMT1) in trophoblast cells. J Cell Physiol. 2005; 204 901-912 10 Nicolas G, Bennoun M, Devaux I et al..[doi.org]
Pleural Effusion
  • Serial chest radiographs showed bilateral pleural effusions, and an ultrasound of the abdomen demonstrated ascites. An echocardiogram showed normal cardiac structure and good contractility of both ventricles.[ncbi.nlm.nih.gov]
  • Pleural Effusion- Short of breath.[epainassist.com]

Treatment

  • In 9 of 12 infants, liver disease resolved within 6 wk following treatment with thyroxine, hydrocortisone and, where appropriate, growth hormone, including Cases 9 and 1 in whom diagnosis and treatment were delayed until 3 mo and 3 y of age, respectively[ncbi.nlm.nih.gov]
  • In addition to the standard treatments, our team of certified pediatric hepatologists is also at the forefront of treatment research, treating adolescents with newly approved treatments for adults and conducting clinical trials to help make them available[childrenshospital.org]

Prognosis

  • Although the prognosis varies for the familial and sporadic forms of neonatal hepatitis, a poor outcome is generally distinguished by chronic and progressive liver failure.[ncbi.nlm.nih.gov]
  • Prognosis of babies with neonatal hepatitis. Abstract 105 babies with neonatal hepatitis were studied carefully and followed for up to 11 1/2 years.[adc.bmj.com]

Etiology

  • Liver biopsy distinguishes NGCH from other etiologies.[nature.com]
  • The case of a young woman with GB virus C/hepatitis G virus (GBV-C/HGV) infection and with a severe exacerbation of chronic hepatitis of unknown etiology during pregnancy is described.[ncbi.nlm.nih.gov]
  • Terminology Also known as neonatal giant cell hepatitis because of frequent syncytial giant cell formation Etiology Intrahepatic neonatal cholestasis accounts for 60 - 70% of all neonatal cholestasis Usual causes include ( Front Pediatr 2015;3:43 ):[pathologyoutlines.com]

Epidemiology

  • Published by Oxford University Press on behalf of the International Epidemiological Association 2016. This work is written by US Government employees and is in the public domain in the United States.[academic.oup.com]
  • Dick MC, Mowat AP (1985) Hepatitis syndrome in infancy — an epidemiologic survey with 10 year follow up. Arch Dis Child 60: 512–516 PubMed CrossRef Google Scholar 15.[link.springer.com]
  • Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv. 2002; 57 :245–256. [ PubMed ] [ Google Scholar ] 8. Fowler KB, Stagno S, Pass RF.[ncbi.nlm.nih.gov]
  • Epidemiology Neonatal hemochromatosis is rare. [6] To date, no rates of this disease are reported. Studies suggest a genetic prevalence of 0.03-0.038 or a heterozygosity prevalence of 6-7%.[emedicine.medscape.com]
  • Epidemiology Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life; about 10% of breast-fed babies are still jaundiced at 1 month of age [ 3 ].[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • This study demonstrates the possibility of metabolomics as non-invasive biomarkers for the early detection of BA and also provides new insight into pathophysiologic mechanisms for BA.[ncbi.nlm.nih.gov]
  • Etiology/Pathophysiology: These two entities are thought to be in the spectrum of the same inflammatory process with more advanced sclerosing cholangitis of the extrahepatic ducts in biliary atresia.[virtualpediatrichospital.org]
  • This video covers the known pathophysiology, important clinical signs and symptoms, laboratory results, and treatments for hepatitis in newborns.[commons.wikimedia.org]
  • Metabolomics, for example, using proton nuclear magnetic resonance spectroscopy, could detect compounds related to genetic modification or pathophysiological stimuli (41) .[journals.lww.com]

Prevention

  • CONCLUSIONS: This pilot project provides grounds for further exploring how midwives prioritise and conceptualise their health promoting role with regard to infectious disease prevention.[ncbi.nlm.nih.gov]
  • This hypothesis led to a trial of gestational treatment to prevent the recurrence of severe NH, which has been highly successful adding strength to the alloimmune hypothesis.[citeseerx.ist.psu.edu]
  • 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.[epainassist.com]

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