Journal of Neonatal Biology

Commentary on Neonatal Hepatitis

Jing Liu^* Neonatal Intensive Care Unit (NICU), China
^*Correspondence: Jing Liu, Neonatal Intensive Care Unit (NICU), China, Email:

Received: 18-Jun-2021 Published: 01-Jul-2021

Commentary

Neonatal hepatitis is inflammation of the liver that occurs only in early infancy, usually between one and two months after birth. About 20 percent of infants with neonatal hepatitis are infected by a virus that caused the inflammation before birth by their mother or shortly after birth. These include cytomegalovirus, rubella (measles) and hepatitis A, B or C viruses. In the remaining 80 percent of cases, no specific virus can be identified as the cause, but many experts suspect that a virus is to blame. An infant with neonatal hepatitis usually has jaundice (yellow eyes and skin), that appears at one to two months of age, is not gaining weight and growing normally and has an enlarged liver and spleen. The infant cannot absorb vitamins for proper growth. Syndrome of Neonatal hepatitis and atresia of extrahepatic bile ducts are the most frequent causes of jaundice with conjugated bilirubin in the small infant. The neonatal hepatitis is diagnosed by its plurietiologic character, onset in the first 3 months, subacute or chronic, potentially cirrhogenous, evolution, conjugated hyperbilirubinemia and mainly, gigantocellular hepatic transformation--the essential characteristic of the diagnosis. Etiology of neonatal hepatitis has extremely diverse causes: infectious causes, genetic diseases of metabolism, toxic causes, post-hemolytic states, neonatal acute hepatic necroses, parenteral nutrition, chromosomal anomalies, familial syndromes, etc.; there exists also a form with nonspecific cause (idiopathic form). Practically, neonatal hepatitis might often be mistaken for atresia of the extrahepatic bile ducts. In the latter case, the temporization of the surgery (bilidigestive anastomosis) for more than 2 months of cholestasis evolution leads to the appearance of hepatic cirrhosis lesions. The authors analyze various clinical, biological and histopathological elements which permit the differentiation in due time of the two situations that require different therapeutic attitudes. Except for certain situations, which allow an etiologic treatment, the main therapeutic element (pathogenic) is corticotherapy and several additional measures. The paper concludes with appreciations on the evolution, prognosis and prophylaxis possibilities. Conjugated hyperbilirubinaemia in an infant indicates neonatal liver disease. This neonatal hepatitis syndrome has numerous possible causes, classified as infective, anatomic/structural, metabolic, genetic, neoplastic, vascular, toxic, immune and idiopathic. Any infant who is jaundiced at 2-4 weeks old needs to have the serum conjugated bilirubin measured, even if he/she looks otherwise well. If conjugated hyperbilirubinaemia is present, a methodical and comprehensive diagnostic investigation should be performed. Early diagnosis is critical for the best outcome. In particular, palliative surgery for extrahepatic biliary atresia has the best chance of success if performed before the infant is 8 weeks old. Definitive treatments available for many causes of neonatal hepatitis syndrome should be started as soon as possible. Alternatively, liver transplantation may be life saving. Supportive care, especially with attention to nutritional needs, is important for all infants with neonatal hepatitis syndrome.