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Neonatal hepatitis--an autopsy study of 14 cases
T M Shet1, B M Kandalkar, I M Vora
1Department of Pathology, T.N. Medical College, Mumbai.
Insights
Neonatal hepatitis in infants is often caused by infections like cytomegalovirus and herpes. Early maternal screening and diagnosis are crucial for preventing fatal outcomes in these severe cases.
Area of Science:
- Pathology
- Neonatal Medicine
- Infectious Diseases
Background:
- Neonatal hepatitis is a significant cause of liver disease in newborns.
- Identifying the etiology of neonatal hepatitis is critical for management and prognosis.
Purpose of the Study:
- To investigate the causes of neonatal hepatitis in autopsy cases.
- To identify infectious agents and other potential factors contributing to neonatal hepatitis.
Main Methods:
- Autopsy examination of fourteen neonatal hepatitis cases.
- Histopathological analysis including orcein stain and Periodic Acid Schiff (PAS) with diastase staining.
- Clinical data review for prenatal and perinatal factors.
Main Results:
- Seven cases were attributed to infections: cytomegalovirus (4), congenital syphilis (2), and neonatal herpes (1).
- Seven cases were classified as Idiopathic Neonatal Hepatitis (INH), with six showing giant cell changes and evidence of intrauterine infection.
- Hepatitis B virus infection and alpha-1-antitrypsin deficiency were unlikely due to negative staining.
Conclusions:
- Infectious etiologies are a major cause of severe neonatal hepatitis.
- Prenatal insults, including infections and low birth weight, are associated with INH.
- Maternal screening for infections and prompt clinical diagnosis are essential for preventing mortality.
Abstract:
Fourteen autopsy cases of neonatal hepatitis have been studied. Of these seven cases were due to infections viz.: cytomegalovirus infection (four cases), probable cases of congenital syphilis (two cases) and neonatal herpes (one case). The remaining seven cases were of Idiopathic Neonatal Hepatitis (INH) with giant cell change in six cases. Even in these cases (INH) there was a high index of suspicion of intrauterine or acquired infection in view of severe mononuclear inflammation in the pancreas, alimentary tract and lungs. Most of these neonates with INH had low birth weight and two were preterm pointing towards a prenatal insult. The orcein stain and Periodic Acid Schiff (PAS) with diastase in all the cases were negative making hepatitis B virus infection and infinity 1 antitrypsin deficiency less likely. These autopsies represent the tip of the iceberg and only the severe cases of infection. The fatal outcome could have been prevented by maternal screening for infections and earlier clinical diagnosis.