|What is neonatal hepatitis?
Neonatal hepatitis is an inflammation of the liver that occurs in early infancy, usually one to two months after birth. About 20 per cent of infants who develop neonatal hepatitis were infected with a virus causing inflammation of the liver either before birth through their mother, or shortly after birth. Viruses which can cause neonatal hepatitis in infants include cytomegalovirus, rubella (measles), and hepatitis A, B and C. In the remaining 80 per cent of affected infants, no specific cause can be identified, but many experts suspect a virus is to blame.
What are the symptoms of neonatal hepatitis?
An infant with neonatal hepatitis usually has jaundice (yellow eyes and skin) that appears at one to two months of age. Jaundice occurs when the flow of bile from the liver is blocked due to an inflammation or obstruction of the bile ducts. Since bile is essential in the digestion of fats and absorption of fat soluble vitamins, a child with neonatal hepatitis may fail to gain weight and grow normally. The infant will also have an enlarged liver and spleen.
How is neonatal hepatitis diagnosed?
The diagnosis of neonatal hepatitis is initially based on blood tests aimed at identifying possible viral infections leading to the disease. In cases where no virus is identified, a liver biopsy is performed. This involves the removal of a small piece of the liver using a special syringe for examination under a microscope.
Biopsy results will often show that groups of four or five liver cells have joined together to form larger cells. Although these large cells continue to function, they do so at a lesser rate than normal liver cells. This type of neonatal hepatitis is sometimes called giant cell hepatitis.
The symptoms of neonatal hepatitis are similar to those associated with another infant liver disease called biliary atresia. In infants with biliary atresia however, bile ducts are progressively destroyed for reasons that are poorly understood. Although an infant with biliary atresia is also jaundiced with an enlarged liver, there is generally normal growth and the spleen is not inflamed. In addition to symptoms, a liver biopsy and blood tests are needed to distinguish biliary atresia from neonatal hepatitis.
What complications are associated with neonatal hepatitis?
Infants with neonatal hepatitis caused by rubella or cytomegalovirus are at risk of developing an infection of the brain that could lead to mental retardation or cerebral palsy. Many of these infants will also have permanent liver disease due to the destruction of liver cells and the resulting scarring (cirrhosis).
The majority of infants with giant cell hepatitis will recover with little or no scarring to the liver. Their growth pattern will also normalize as bile flow improves. However, about 20 per cent of affected infants will go on to develop chronic (ongoing) liver disease and cirrhosis. In these children, the liver becomes very hard due to scarring, and the jaundice does not dissipate by six months of age. Infants who reach this point in the disease eventually require a liver transplant.
Infants with chronic neonatal hepatitis will not be able to digest fats and absorb fat soluble vitamins (A, D, E and K) as a result of insufficient bile flow and the damage caused to liver cells. The lack of vitamin D will lead to poor bone and cartilage development (rickets). A deficiency in vitamin A may affect normal growth and vision. Vitamin K deficiency is associated with easy bruising and a tendency to bleed, whereas the lack of vitamin E results in poor coordination. Since bile is responsible for the elimination of many toxins in the body, chronic neonatal hepatitis can also lead to a buildup of toxins in the blood which in turn may result in itching, skin eruptions and irritability.
How is neonatal hepatitis treated?
There is no specific treatment for neonatal hepatitis. Vitamin supplements are usually prescribed and many infants are given medications which improve bile flow. Formulas containing fats more easily digested by the body are also given.
Can neonatal hepatitis be spread to others?
Infants with neonatal hepatitis caused by the cytomegalovirus, rubella or viral hepatitis may transmit the infection to others who come in close contact with them. These infected infants should not come into contact with pregnant women because of the possibility that the woman could transmit the virus to her unborn child.
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