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Infantile acute liver failure in the West of Scotland
David Wands1, Rachel Tayler2, Deirdre Kelly3
1Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children Glasgow, Glasgow, UK.
Insights
Infantile acute liver failure is more common than previously thought, with hypoxic birth injury and ischemic events being leading causes. This study highlights potential underdiagnosis in current data collection methods for pediatric liver disease.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Research
Background:
- Current understanding of infantile acute liver failure (ALF) etiology relies on regional data, potentially causing selection bias.
- This may not accurately represent the broader pediatric population affected by ALF.
Purpose of the Study:
- To determine the incidence and common etiologies of ALF in infants.
- To assess the survival rate of infants diagnosed with ALF.
- To evaluate the effectiveness of a comprehensive screening methodology for ALF.
Main Methods:
- Retrospective review of electronic records for all infants (<1 year) with a prothrombin time ≥18 seconds over one year.
- Utilized a 'catch-all' methodology to identify all ALF cases.
Main Results:
- Identified 24 cases of ALF from 9989 coagulation screens.
- Hypoxic birth injury and ischemic events were the most frequent causes.
- Observed a 75% survival rate among the identified patients.
Conclusions:
- ALF in infants appears more prevalent than previously reported.
- Current data may underestimate ALF incidence due to self-resolving or rapidly fatal cases.
- The employed methodology provides a more comprehensive view of pediatric ALF.
Background:
Our current understanding regarding the aetiology of infantile acute liver failure largely derives from studies conducted by regional liver units. This may introduce selection bias and therefore not provide a true reflection of the wider population.
Methods:
Every coagulation screen with a prothrombin time ≥18 s in our centre was examined over one calendar year. All patients less than 1 year of age were included and their electronic records retrospectively reviewed.
Results:
24 patients were identified, from 9989 coagulation screens, that fit the current definition of acute liver failure. Hypoxic birth injury and ischaemic events were the most common aetiologies. Survival was 75%.
Conclusion:
The 'catch-all' methodology employed demonstrated that acute liver failure is more common than previously reported and suggests that current data may exclude large numbers who either have more minor self-resolving disease or conversely have severe disease leading to death prior to transfer.
