Neonatal Hepatitis: Causes, Symptoms, Diagnosis And Treatment

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The inflammation of the liver in newborns is known as neonatal hepatitis. This normally happens one or two months after the baby is born. While it might be a sign of liver disease in certain cases, the exact etiology remains unknown in several cases.

Viruses transmitted from the mother before or shortly after birth account for nearly 20% of the cases (1). It is mostly characterized by jaundice and increased liver enzymes, where the jaundice is caused when the liver cells become inflamed and obstruct the flow of bile (neonatal cholestasis).

Read on as we discuss the causes, symptoms, complications, diagnosis, and treatment options for hepatitis in neonates.

Causes Of Neonatal Hepatitis

Neonatal hepatitis can be caused by various factors that impair liver function. Viruses are one of the most common causes of hepatitis in newborns. Other infections, immune problems, anatomical or structural issues, and genetic or metabolic disorders can also contribute to neonatal hepatitis. However, many babies who develop hepatitis do not have known cause.

The cause of neonatal hepatitis could vary depending on its type.

  1. Viral neonatal hepatitis: Babies may get various viruses before or immediately after birth. Some of these viruses can cause hepatitis. Hepatitis A, B, and C, rubella, and cytomegalovirus are common viruses that cause hepatitis in neonates (1).
  1. Hepatitis due to metabolic and genetic conditions: Various inherited metabolic disorders can cause neonatal jaundice. Alpha1-antitrypsin deficiency, Wilson’s disease, cystic fibrosis, and progressive familial intrahepatic cholestasis (PFIC) syndromes are common inherited metabolic disorders of the liver. Neonatal hepatitis can be the beginning stage of these inherited disorders(2).
  1. Idiopathic neonatal hepatitis: Idiopathic neonatal hepatitis (INH) is when the infant has prolonged cholestasis and other symptoms without a known cause(3). Although the cause is unknown, some babies with INH may have specific histologic findings on liver biopsy. For example, giant cells are seen in liver biopsies in some infants. Giant cells are a fusion of abnormal liver cells, and this type of hepatitis is called idiopathic giant cell hepatitis.

Is Neonatal Hepatitis Contagious?

Not all cases of neonatal hepatitis are contagious or spread to others(4). Neonatal hepatitis caused by metabolic or genetic factors does not spread from one to another. However, neonatal viral hepatitis can be contagious and spread to others in specific conditions. For example, the infections can transmit through the fecal-oral route through unwashed hands.

Signs And Symptoms Of Neonatal Hepatitis

Common signs and symptoms of neonatal hepatitis may include(1):

  • Jaundice (yellow eye and skin), which may develop later than normal in babies aged one or two months.
  • Poor growth and weight gain due to inadequate vitamin absorption
  • Hepatomegaly (liver enlargement)
  • Splenomegaly (spleen enlargement)

These signs and symptoms can also be seen in various other conditions in babies. You may consult a pediatrician for an exact diagnosis.

Complications Of Neonatal Hepatitis

Complications of neonatal hepatitis may depend on the cause(5). The following complications are often seen:

  • Encephalitis is the infection of the brain that often leads to cerebral palsy and mental retardation in some babies. Infants with neonatal hepatitis due to rubella or cytomegalovirus are more likely to develop encephalitis.
  • Liver cirrhosis is often seen in infants with hepatitis lasting more than six months.
  • Skin problems such as itching and eruptions are seen in chronic neonatal hepatitis.
  • Cholestasis is the decreased bile flow that may occur in neonatal hepatitis, resulting in inadequate vitamin absorption from the intestines.
  • Vitamin A, D, E, and K deficiency may occur in some babies. This may result in growth delays, poor bone development, skin changes, and bleeding problems in babies.

Diagnosis Of Neonatal Hepatitis

The presence of jaundice and physical examination helps the doctors identify enlarged liver and spleen in babies. Babies with hepatitis may get a referral to a pediatric gastroenterologist for detailed evaluation. Blood tests are conducted to determine the following parameters (6).

  • Elevated bilirubin levels help confirm jaundice.
  • Antibody tests help identify the type of hepatitis and severity of infection. It also determines whether the hepatitis is active or dormant.
  • Liver enzyme AST/ALT levels in blood show liver function.
  • Prothrombin time measures the time required for plasma to clot. This also indicates liver functioning.
  • Other specific blood tests may help to identify metabolic conditions.

In addition to the blood tests, doctors may also order imaging tests to visualize the liver. For example, ultrasound and hepatobiliary iminodiacetic acid (HIDA) scan (nuclear medicine test) could provide a detailed view of liver tissues and pathologies. In some cases, a liver biopsy is done to evaluate the tissue changes. These tests are necessary to confirm diagnosis since conditions such as biliary atresia may be associated with neonatal hepatitis.

Treatment For Neonatal Hepatitis

There is no specific treatment for neonatal hepatitis in most cases(1). Supportive care and symptom-based management are given during this condition, depending on the cause. Infants may receive vitamin supplementation and formulas containing easily digestible fats to have optimal growth.

Liver transplantation is recommended for babies with severe permanent liver damages. Treatments with antivirals, such as lamivudine and interferon alpha, are usually not approved for infants. However, doctors may recommend certain treatments based on risks and benefits.

Prognosis Of Neonatal Hepatitis

In most cases, neonatal hepatitis resolves on its own over time. It may take weeks or months to recover from the condition (4). Some may develop mild liver damage (fibrosis), and this may improve over time.

In some babies, neonatal hepatitis due to the hepatitis A virus may resolve within six months(1). However, hepatitis B or C viruses may lead to chronic liver diseases. Some babies with severe liver damage (liver cirrhosis) followed by hepatitis may require liver transplantation.

Frequently Asked Questions

1. Is hepatitis A a lifelong disease?

According to the World Health Organization (WHO), hepatitis A may not last for all one’s life, and most individuals recover from the disease with long-term immunity. However, in rare cases, it may be fatal in people with severe liver impairment (fulminant hepatic failure) (7).

2. What color is a stool with cholestasis?

Studies reveal that neonates with cholestatic jaundice or cholestasis may typically have pale or gray-colored stools (also called acholic stools) and dark yellow-colored urine (8).

Neonatal hepatitis may occur due to viral infections, metabolic disorders, or structural defects and can cause jaundice in babies younger than three months. The treatment depends on the underlying cause and the severity of the condition. Some cases may resolve themselves and not cause future complications, while particular forms of viral hepatitis need rigorous therapies or even liver transplantation. Poorly managed neonatal hepatitis may lead to complications such as brain infection and liver damage. Seek prompt medical care if you observe any symptoms of neonatal hepatitis in your baby.

Key Pointers

  • Yellowish discoloration of eyes and skin and poor weight gain or loss of weight are the primary signs of neonatal hepatitis.
  • In most cases, neonatal jaundice resolves on its own in a few weeks or months.
  • Rarely, neonatal hepatitis may lead to encephalitis, liver cirrhosis, skin problems, etc.

References:

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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more

Dr. Jessica Madden

(MD, FAAP, IBCLC)
Jessica Madden is a pediatrician, neonatologist, lactation consultant, and mother of four, who has been taking care of newborns since 2001. She works as a neonatologist in the NICU at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and founded Primrose Newborn Care, a newborn medicine and “4th trimester” home-visiting and telemedicine practice, in 2018.  Dr. Madden is a Fellow... more

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