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Cytomegalovirus-associated neonatal hepatitis
1Department of Pediatrics, College of Medicine, National Taiwan University Hospital, Taipei, R.O.C.
Insights
Cytomegalovirus (CMV)-associated neonatal hepatitis (NH) can lead to long-term health issues in over 20% of survivors. Clinical factors, not CMV seropositivity, predict unfavorable outcomes in infants with NH.
Area of Science:
- Neonatology
- Pediatric Hepatology
- Infectious Diseases
Background:
- Neonatal hepatitis (NH) is a significant cause of liver disease in newborns.
- Cytomegalovirus (CMV) is a common congenital infection that can cause neonatal hepatitis.
Purpose of the Study:
- To evaluate the long-term outcomes of infants diagnosed with CMV-associated neonatal hepatitis.
- To identify clinical and pathological factors associated with unfavorable outcomes in these patients.
Main Methods:
- A longitudinal follow-up study of 55 infants with CMV-associated NH.
- Data collection included clinical presentation, laboratory values, liver pathology, and developmental assessments up to 90 months.
- Statistical analysis to correlate clinical parameters with patient outcomes.
Main Results:
- Six patients (10.9%) died due to fulminant or chronic liver disease.
- Among 49 survivors, 20.4% experienced long-term impacts, including developmental/growth retardation and hearing impairment.
- Unfavorable outcomes were linked to persistent clay-colored stools, splenomegaly, ascites, anemia, high bilirubin, low albumin, giant cell transformation, and cirrhosis.
- CMV seropositivity did not significantly correlate with outcomes.
Conclusions:
- CMV-associated neonatal hepatitis carries a substantial risk of mortality and long-term sequelae in survivors.
- Specific clinical and pathological findings are critical indicators of prognosis, independent of CMV infection status.
- Early identification of these risk factors is crucial for managing infants with CMV-associated NH.
Abstract:
Fifty-five patients with cytomegalovirus (CMV)-associated neonatal hepatitis (NH) were followed for 12 to 90 months. Six patients (10.9%) died from either a fulminant course or a chronic liver disease. Among the remaining 49 patients, whose liver function was completely recovered, there were eight with retardation of developmental or growth status, and two with hearing impairment. Overall, 20.4% of the survivors suffered from a long-term impact. The unfavorable outcome was related to several clinical and pathological parameters. These included persistence of clay-colored stool, presence of splenomegaly, ascites or anemia, high peak total and direct bilirubin, low nadir albumin levels, diffuse giant cell transformation and cirrhosis of the liver. The seropositivity of CMV infection did not significantly correlate with the outcome.