Idiopathic Neonatal Hepatitis

Idiopathic Neonatal Hepatitis

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Idiopathic Neonatal Hepatitis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • INH
  • neonatal giant cell hepatitis
  • idiopathic neonatal hepatitis syndrome

Disorder Subdivisions

  • None

General Discussion

Neonatal hepatitis is a general term for inflammation of the liver (hepatitis) that occurs shortly after birth. Neonatal hepatitis may be caused by viruses, certain metabolic or genetic disorders, and other rare diseases that affect or impair the function of the liver. In some children, the cause of liver inflammation is unknown - these cases are referred to as idiopathic neonatal hepatitis (INH). The symptoms of idiopathic neonatal hepatitis may vary greatly from one individual to another. Symptoms common to liver disease often occur including yellowing of the whites of the eyes and the skin (jaundice), enlargement of the liver (hepatomegaly) and unusually dark urine. Most individuals with idiopathic neonatal hepatitis fully recover from the condition; however, some will progress to chronic liver disease.

Symptoms

The liver is located on the right side of the abdominal cavity just under the rib cage. The liver has many different functions including filtering harmful substances (toxins) out of the bloodstream, storing essential vitamins, helping to breakdown (metabolize) food to use as energy, creating enzymes that help the blood form clots in response to injury, and producing bile, a liquid that plays an essential role in carrying waste products from the liver and breaking down fats in the small intestine.



In many cases, the first sign of liver disease is yellowing of the whites of the eyes and the skin (jaundice). Some infants with idiopathic neonatal hepatitis may also have an enlarged liver (hepatomegaly). Additional symptoms that may occur include unusually dark urine and pale or clay-colored (acholic) stools.



The disorder can range from a mild, temporary (transient) disease that improves without treatment to more serious forms that cause additional complications. The common symptoms of liver disease may appear anytime during the first few weeks of life in affected infants. Affected infants often have a low birth weight.



By the age of 2 to 3 months, it becomes clear that an infant with neonatal hepatitis is not gaining weight and is growing at a slower than normal rate (failure to thrive). The infant may be irritable because of excessively itchy skin (pruritus). Other symptoms may include abnormal enlargement of the spleen (splenomegaly) and/or the abnormal accumulation of body fluids within the abdomen (ascites).



In more serious forms of neonatal hepatitis additional symptoms can occur including easy bruising, prolonged bleeding, and infection of the blood (sepsis). Liver (hepatic) failure may eventually develop in some individuals with severe forms of neonatal hepatitis.

Causes

Neonatal hepatitis, in general, has many different causes including several different viruses including cytomegalovirus and the hepatitis viruses; various metabolic or genetic disorders such as alpha-1-antitrypsin deficiency; and rare disorders that impair the function of the liver (cholestatic disorders). If none of the known causes of neonatal hepatitis can be identified, it is referred to as idiopathic neonatal hepatitis.



By definition, the cause of idiopathic neonatal hepatitis is not known. Most cases are believed to occur randomly (sporadically). Idiopathic neonatal hepatitis occurs in approximately 10-25 %of infants with neonatal cholestasis - a common condition of newborns in which the flow of bile from the liver is reduced or blocked resulting in jaundice.



According to the medical literature, approximately 15-20 percent of cases of idiopathic neonatal hepatitis run in families (familial form) suggesting that genetic factors play a role in its development.

Affected Populations

The incidence of idiopathic neonatal hepatitis in the general population is unknown. The proportion of cases classified as "idiopathic" has diminished as advanced diagnostic techniques and a better molecular understanding of cholestatic diseases in general have allowed physicians to diagnosis many infants with specific syndromes. In the past, these infants would have been included as having idiopathic neonatal hepatitis.

Standard Therapies

Diagnosis

Idiopathic neonatal hepatitis is a diagnosis attained by excluding other conditions. Tests may be conducted to rule out viral as well as metabolic diseases and other genetic causes of liver disease. Blood tests may reveal elevated levels of bilirubin in the blood (hyperbilirubinemia) and decreased levels of certain vitamins because of the failure to the body to proper breakdown food.



The structure of the liver and the surrounding ducts and blood vessels can be examined by ultrasonography. In some cases, a liver biopsy may be necessary. During a biopsy, a needle and syringe are used to remove a small piece of liver tissue. This sample is studied under a microscope. A liver biopsy may be able to rule out other liver disorders such as those that affect the inside of the liver (intrahepatic disorders).



Treatment

There is no specific treatment available for infants with idiopathic neonatal hepatitis. Treatment is directed toward the specific symptoms that are apparent in each individual.



Careful attention to nutritional needs and diet are essential for infants with this disorder. Special supplements (i.e., fat-soluble vitamins), formulas, and/or dietary restrictions may be suggested by the physician. Special infant formulas may be prescribed, for example, malabsorption of long-chain triglycerides may be corrected with formulas that contain medium-chain triglycerides.



If itching (pruritus) becomes a problem, a drug that has been used to treat itching associated with liver disease is ursodeoxycholic acid.



A surgical choice of last resort for infants who develop end-stage liver disease is a liver transplantation.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



Contact for additional information about idiopathic neonatal hepatitis:



William F. Balistreri, M.D.

Director, Pediatric Liver Care Center

Division of Pediatric Gastroenterology,

Hepatology, and Nutrition

Cincinnati Children's Hospital Medical Center

3333 Burnet Avenue

Cincinnati, Ohio 45229-3039

Phone: 513-636-4594

Fax: 513-636-7805

e-mail: w.balistreri@CCHMC.org

References

TEXTBOOKS

Behrman RE, Kliegman RM, Jenson HB. Eds. Nelson Textbook of Pediatrics. 19th ed. Elsevier Saunders. Philadelphia, PA; 2011.



Patrinos ME, Harrigan R. Idiopathic Neonatal Hepatitis. NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:288.



Liver Disease in Children, 3rd Edition, Suchy F, Sokol R, Balistreri WF (2006)



JOURNAL ARTICLES

Balistreri WF, Bezerra JA. Whatever happened to neonatal hepatitis? Clin Liver Dis. 2006;10:27-53.



FROM THE INTERNET

The Merck Manuals Online Medical Library. Neonatal Cholestasis. November, 2007. Available at: http://www.merck.com/mmpe/sec19/ch275/ch275f.html Accessed: December 2011.

Resources

March of Dimes Birth Defects Foundation

1275 Mamaroneck Avenue

White Plains, NY 10605

Tel: (914)997-4488

Fax: (914)997-4763

Tel: (888)663-4637

Email: Askus@marchofdimes.com

Internet: http://www.marchofdimes.com



American Liver Foundation

39 Broadway, Suite 2700

New York, NY 10006

USA

Fax: (212)483-8179

Tel: (800)465-4837

Email: http://www.liverfoundation.org/contact/

Internet: http://www.liverfoundation.org



NIH/National Institute of Diabetes, Digestive & Kidney Diseases

Office of Communications & Public Liaison

Bldg 31, Rm 9A06

31 Center Drive, MSC 2560

Bethesda, MD 20892-2560

Tel: (301)496-3583

Email: NDDIC@info.niddk.nih.gov

Internet: http://www2.niddk.nih.gov/



Children's Liver Disease Foundation

36 Great Charles Street

Birmingham, B3 3JY

United Kingdom

Tel: 01212123839

Fax: 01212124300

Email: info@childliverdisease.org

Internet: http://www.childliverdisease.org



Canadian Liver Foundation

3100 Steeles Avenue East Suite 801

Markham Ontario, L3R 8T3

Canada

Tel: 4164913353

Fax: 9057521540

Tel: 8005635483

Email: clf@liver.ca

Internet: http://www.liver.ca



Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904

Tel: (301)622-4200

Fax: (301)622-4702

Tel: (800)891-0707

Email: hfi@comcast.net

Internet: http://www.hepatitisfoundation.org



British Liver Trust

2 Southampton Road

Ringwood, BH24 1HY

United Kingdom

Tel: 01425481320

Fax: 01425481335

Tel: 08006527330

Email: info@britishlivertrust.org.uk

Internet: http://www.britishlivertrust.org.uk



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



Madisons Foundation

PO Box 241956

Los Angeles, CA 90024

Tel: (310)264-0826

Fax: (310)264-4766

Email: getinfo@madisonsfoundation.org

Internet: http://www.madisonsfoundation.org



CORE

3 St. Andrews Place

London, NW1 4LB

United Kingdom

Tel: 02074860341

Fax: 02072242012

Email: info@corecharity.org.uk

Internet: http://www.corecharity.org.uk



Childhood Liver Disease Research and Education Network

c/o Joan M. Hines, Research Administrator

Children's Hospital Colorado

13123 E 16th Ave. B290

Aurora, CO 80045

Tel: (720)777-2598

Fax: (720)777-7351

Email: joan.hines@childrenscolorado.org

Internet: http://www.childrennetwork.org



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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