What is neonatal hepatitis?

Neonatal hepatitis is inflammation of the liver that occurs only in early infancy, usually between one and two months after birth. About 20 percent of infants with neonatal hepatitis are infected by a virus that caused the inflammation before birth by their mother or shortly after birth. These include cytomegalovirus, rubella (measles) and hepatitis A, B or C viruses. In the remaining 80 percent of cases, no specific virus can be identified as the cause, but many experts suspect that a virus is to blame.

Symptoms

An infant with neonatal hepatitis usually has jaundice (yellow eyes and skin), that appears at one to two months of age, is not gaining weight and growing normally and has an enlarged liver and spleen. The infant cannot absorb vitamins for proper growth.

Diagnosis

In the 80 percent of the cases where there is no virus identified as the cause, a liver biopsy is performed, where a small piece of the liver is taken out of the child with a needle and examined under a microscope. The biopsy will often show that four or five liver cells are combined into a large cell that still functions but doesn’t function as well as a normal liver cell. This type of neonatal hepatitis is sometimes called giant cell hepatitis. The symptoms of neonatal hepatitis are similar to biliary atresia, in which the bile ducts are destroyed for reasons that are not understood. An infant with biliary atresia also has jaundice and an enlarged liver but is growing well and does not have an enlarged spleen. These symptoms, along with a liver biopsy and blood tests, are needed to distinguish biliary atresia from neonatal hepatitis.

Treatment

There is no specific treatment for neonatal hepatitis. Vitamin supplements are usually prescribed, and many infants are given phenobarbital, a drug used to control seizures but which also stimulates the liver to excrete additional bile. Formulas containing more easily digested fats are also given to the infant. Neonatal hepatitis caused by the hepatitis A virus usually resolves itself within six months, but cases that are the result of infection with the hepatitis B or C viruses most likely will result in chronic liver disease. Infants who develop cirrhosis will ultimately need a liver transplant.