Neonatal Hepatitis: Causes, Symptoms, and Treatment Options Explained

What Is Hepatitis?

Hepatitis refers to an inflammation or swelling in the liver. However, the condition is more complex. Inflammation, anywhere in the body, can cause tissue damage; therefore, hepatitis indicates damaged liver tissues. Moreover, inflammation in the liver can further damage the liver tissues. Hepatitis can occur due to autoimmune causes, viral infections (hepatitis A, B, or C virus), alcoholism, use of certain drugs or drug toxicity, or certain medical conditions. Common symptoms of hepatitis include; fever, tiredness, fatigue, loss of appetite, nausea, vomiting, pain in the abdomen, jaundice, and joint pain. Hepatitis can be chronic (long-term) or acute (short-term). Complications from chronic hepatitis include liver cancer, liver failure, and cirrhosis (liver scarring). The World Health Organization (WHO) states that 354 million people worldwide suffer from chronic hepatitis B and C.

What Is Neonatal Hepatitis?

Neonatal hepatitis or congenital hepatitis is the inflammation or swelling of the liver seen in infants, usually between the ages of one to two months post-birth. Neonatal hepatitis is a type of liver dysfunction that can affect fetuses and newborns. Moreover, neonatal hepatitis can also be a symptom of several other diseases that may affect newborns. However, "neonatal hepatitis" is frequently used as a diagnosis in place of or in addition to "idiopathic neonatal hepatitis" to refer to liver inflammation that occurs in the early stages of infancy but cannot be linked to a particular known cause. Although the exact causes of neonatal hepatitis are unknown, they may include viral infections, an immature liver in the newborn, and stress on the liver from other health problems during infancy.

What Causes Neonatal Hepatitis?

Numerous infectious, anatomical or structural, metabolic, genetic, neoplastic, vascular, toxic, immunological, and idiopathic factors can lead to newborn hepatitis. Some of the causes are as follows:

• Viral Infection: Cytomegalovirus, rubella virus, hepatitis A and B viruses, herpes simplex viruses, coxsackievirus, echovirus, and paramyxovirus are among the viruses known to cause neonatal hepatitis.

• Infected Mother: A virus that causes inflammation before delivery by the mother or soon after birth is the cause of neonatal hepatitis in about 20 % of infants.

• Autoimmune Disease: This condition occurs when the body’s immune system starts attacking the healthy cells. The immune system of the body creates antibodies that destroy the liver in autoimmune liver disease, creating an inflammatory response that results in hepatitis.

• Metabolic Disorders: Some newborns experience a metabolism issue that results in liver disease.

• Idiopathic Giant Cell Hepatitis: Idiopathic describes a disorder for which there is no known reason. Giant cells are unusual groups of liver cells fused together. In newborns, this pattern of damaged cells is frequently seen without any obvious disease. Although a small number of infants with idiopathic neonatal hepatitis go on to develop chronic liver disease, most do well.

What Are the Symptoms of Neonatal Hepatitis?

Symptoms of neonatal hepatitis are:

• The newborn develops jaundice (yellow discoloration of the skin, eyes, and palm) within two to four weeks after birth. A substance called bilirubin accumulates in the baby's blood and tissues, resulting in jaundice.

• Enlarged liver and spleen.

• Sometimes, neonatal hepatitis can occur without developing any noticeable symptoms.

• Slow growth and development.

• The newborn fails to gain weight. Due to its inability to absorb the vitamins and other nutrients necessary for growth, a newborn with neonatal hepatitis may be underweight and not grow normally.

• Fever.

• Malaise.

• Fatigue.

• Abdominal pain.

• Diarrhea (frequent watery stool).

• Nausea and vomiting.

• If neonatal hepatitis worsens, symptoms like dark-colored urine and clay-colored stools may also be noticed.

How Is Neonatal Hepatitis Diagnosed?

Neonatal hepatitis is diagnosed in the following ways:

1. Physical Examination: The newborn’s body may show signs of an enlarged liver or spleen when a pediatrician examines it.

2. Blood Examinations: Neonatal hepatitis is detected by a variety of blood tests, including:

• Liver Enzyme Blood Test: By examining the levels of liver enzymes, liver function can be determined.

• Prothrombin Blood Time Test: This test demonstrates that the liver is functioning properly by timing how long it takes for plasma, the liquid element of blood, to clot.

• Complete Blood Count: Complete blood count may also be done to determine the blood's hemoglobin and white blood cell count.

3. Liver Biopsy: A liver biopsy is carried out in 80 percent of instances where no virus is found to be the cause, in which case a small sample of the child's liver is removed with a needle and inspected under a microscope.

4. Urine Analysis: Tests are performed on the urine to look for urobilinogen, protein, hemoglobin, bilirubin, and ketones.

4. Hepatobiliary Iminodiacetic Acid (HIDA) Scan: A hepatobiliary iminodiacetic acid (HIDA) scan is an imaging test used to identify issues with the liver, gallbladder, and bile ducts.

How Is Neonatal Hepatitis Treated?

• Neonatal hepatitis has no specific treatment.

• The underlying cause determines the treatment of neonatal hepatitis.

• Supportive care, a healthy diet, and close post-treatment monitoring are frequently done to treat a newborn with neonatal hepatitis.

• Vitamin supplements are given to assist liver function.

• In addition to vitamin supplements, many newborns receive Phenobarbital, a medication to treat seizures that also causes the liver to secrete more bile.

• The infant is also given formulas that contain fats that are simpler to digest.

• Neonatal hepatitis occurring due to the hepatitis A virus typically clears up on its own in six months, while instances brought on by hepatitis B or C virus infection are more likely to progress to chronic liver disease. Antiviral medication may be necessary for these babies.

• A liver transplant will eventually be required for infants who develop cirrhosis.

What Are the Complications of Neonatal Hepatitis?

Untreated neonatal hepatitis can cause the following complications:

• Encephalitis: Neonatal hepatitis from rubella or the cytomegalovirus can cause brain infections (encephalitis) in infants that can cause cerebral palsy or mental impairment.

• Liver Cirrhosis: The chances of acquiring chronic liver disease and liver cirrhosis are relatively high in approximately 20 % of infants who have neonatal giant cell hepatitis.

• Vitamin Deficiency: Chronic hepatitis prevents infants from absorbing vitamins A, D, E, and K. Rickets is the medical name for inadequate bone development caused by vitamin D deficiency. Poor growth and vision result from vitamin A deficiency. While a vitamin E deficiency causes skin changes, and a vitamin K deficiency is linked to easy bleeding and bruising.

• Liver Cholestasis: Nearly 40 % of all cases of cholestasis are caused by neonatal hepatitis, which is thought to result in several problems, including improper vitamin intake in the gut.

Conclusion:

Neonatal hepatitis is an uncommon condition, and it can occur for various reasons. The treatment and prognosis of neonatal hepatitis depend on the condition's cause. Babies with less prolonged and obstructive jaundice typically have a better prognosis than newborns with consistently acholic stools. The presence of secondary disease, in addition to neonatal hepatitis, can also be responsible for poor prognosis and complications.