Neonatal hepatitis is a term to describe the appearance of jaundice (yellowing of the skin) and/or elevated liver enzymes in infants. Blood work can show elevation in direct or conjugated bilirubin, indicating a liver problem. Some babies later will be diagnosed with other liver diseases while others will never be given a specific diagnosis.

Causes

Some infants with neonatal hepatitis were infected by a virus that caused the inflammation before or shortly after birth. Some infants have a problem in their body's metabolism that causes the liver problem. In some cases no specific cause can be identified.

Many babies with neonatal hepatitis have a liver biopsy finding called idiopathic giant cell hepatitis. Idiopathic means “we do not know why this is happening.” Giant cells are abnormal groups of liver cells fused together. Often, this injury pattern is seen in young livers without reflecting a specific disease. Most babies with idiopathic neonatal hepatitis without a known cause do well, although a few do develop chronic liver disease.

Symptoms

Infants with neonatal hepatitis may have jaundice as their only symptom. Others may grow poorly or may have an enlarged liver or spleen.

Exams and Tests

• Blood tests
• Liver Ultrasound
• Hepatobiliary Scan

Liver Biopsy

Your child will receive sedation medications or a general anesthetic before the biopsy. These medications will prevent your child from feeling pain or anxiety or remembering the procedure. An area on the right side of your child's abdomen or mid-upper abdomen will be cleansed with an antibacterial soap. The biopsy site will then be numbed with an injection of lidocaine (numbing medicine). Your child's pediatric GI specialist will insert a needle through the skin and into the liver to obtain a very small piece of liver tissue. The sample will be sent to a lab and analyzed. The doctor will apply a small pressure dressing (bandage) to the site.

After the biopsy your child will stay in or return to his/her room for four hours, when a repeat blood count is checked. (Children less than one year are observed overnight.) He or she should lie on the right side or back, depending on the biopsy site, for two hours. Being in bed will reduce the chance of bleeding after the biopsy. Once your child is awake and alert, he/she will be allowed to drink fluids. If fluids are tolerated, a regular diet can be restarted. For the remainder of the day, your child will need to participate in quiet activity. The results of the liver biopsy are usually available two weeks after the procedure.

Treatment

Treatment of neonatal hepatitis depends on the underlying cause. In many cases, supportive care with good nutrition and close follow-up are all that is required.

For More Information

Biliary Atresia Research Consortium - barcnetwork.org/families/diseases.html