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Characterization and outcomes of young infants with acute liver failure

Shikha S Sundaram1, Estella M Alonso, Michael R Narkewicz

  • 1Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, The Children's Hospital, University of Colorado School of Medicine, Aurora, CO, USA. sundaram.shikha@tchden.org

The Journal of Pediatrics
|May 31, 2011
PubMed

Insights

Acute liver failure (ALF) in infants under 90 days shows better spontaneous survival than expected. Liver transplantation offers a viable option for infants with ALF, especially those with indeterminate or viral causes.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Neonatal Medicine

Background:

  • Acute liver failure (ALF) in infants presents significant diagnostic and management challenges.
  • Understanding the specific characteristics and outcomes of ALF in neonates and young infants is crucial for improving care.

Purpose of the Study:

  • To characterize the clinical presentation, etiologies, and outcomes of infants aged 90 days or younger with acute liver failure.
  • To analyze survival rates and the role of liver transplantation in this vulnerable population.

Main Methods:

  • Analysis of prospective data from the international, multicenter Pediatric Acute Liver Failure (PALF) Study Group.
  • Inclusion of infants aged ≤ 90 days enrolled in the registry before May 18, 2009.

Main Results:

  • 148 infants with ALF were identified, with a median age of 18 days.
  • Common etiologies included indeterminate causes (38%), neonatal hemochromatosis (13.6%), and herpes simplex virus (12.8%).
  • Spontaneous survival was observed in 60% of infants, 16% received liver transplants, and 24% died without transplantation. Infants with indeterminate ALF had higher rates of liver transplantation compared to viral-induced ALF. Viral ALF was associated with a significantly higher cumulative incidence of death without transplantation.

Conclusions:

  • Acute liver failure in young infants has distinct diagnostic considerations.
  • Spontaneous survival rates for ALF in this age group are more favorable than previously reported.
  • Liver transplantation serves as an important therapeutic option for infants with ALF, improving overall management and outcomes.
Abstract

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