Neonatal Hepatitis Research Articles

Early Childhood Cholestasis, Causes & Associated Factors in Children

Background: Newborn cholestasis is explained as a persisted rise of the serum conjugated bilirubin outside the first two weeks of life. There are many etiologies of newborn cholestasis that must be differentiated since immediate interference may give a better outcome. Objective: Newborn cholestasis is explained as a persisted rise of the serum conjugated bilirubin outside the first two weeks of life. There are many etiologies of newborn cholestasis that must be differentiated since immediate interference may give a better outcome. Patients and Methods: A cross-sectional research of forty-eight children consulting the Childhood Wellbeing Teaching Hospital in Baghdad/Medical City from 1st of November 2018 to the 30th of November 2021, complete evaluation by full history, physical checkup and laboratory studies. Cholestasis was demarcated as an extended raise of the levels of conjugated bilirubin outside the 1st 2 weeks of age above 1.0mg/dl(17.1µmol/l) if the whole serum bilirubin(TSB) is <5.0 mg/dL or above 20% of the TSB if the TSB is >5.0 mg/dl. Results: Out of 48 children involved in the study ,62.5% resided in Baghdad, and the remainder was belonged to other districts. The mean age of children was 11.1 months. The males constituted 58.3% of them. Eleven cases (22.9%) were caused by congenital infection, nine 18.8% had no cause detected, while 16.7% caused by biliary atresia and 16.7% had unidentified etiology, however 10.4% was related to sepsis. Biliary atresia was more frequent in boys in 62.5% compared to 37.5% in females. Family history was positive only in11.1% of idiopathic neonatal hepatitis. It was found that 81% of cholestatic jaundice were caused by congenital infection. In comparison, 62.5% caused by biliary atresia and 60% caused by sepsis appeared on the second week of the child's age, and this difference was significant statistically P-value 0.01. Conclusion: Innate infections are the most frequent source, where CMV contagion is the most commonly detected. Clinical findings included clay colored stool & elevated alkaline phosphatase concentrations observed primarily on biliary atresia. There are no specific test to identify the etiology of newborn cholestasis.

The role of artificial intelligence in the management of liver diseases.

Universal neonatal hepatitis B virus (HBV) vaccination and the advent of direct-acting antivirals (DAA) against hepatitis C virus (HCV) have reshaped the epidemiology of chronic liver diseases. However, some aspects of the management of chronic liver diseases remain unresolved. Nucleotide analogs can achieve sustained HBV DNA suppression but rarely lead to a functional cure. Despite the high efficacy of DAAs, successful antiviral therapy does not eliminate the risk of hepatocellular carcinoma (HCC), highlighted the need for cost-effective identification of high-risk populations for HCC surveillance and tailored HCC treatment strategies for these populations. The accessibility of high-throughput genomic data has accelerated the development of precision medicine, and the emergence of artificial intelligence (AI) has led to a new era of precision medicine. AI can learn from complex, non-linear data and identify hidden patterns within real-world datasets. The combination of AI and multi-omics approaches can facilitate disease diagnosis, biomarker discovery, and the prediction of treatment efficacy and prognosis. AI algorithms have been implemented in various aspects, including non-invasive tests, predictive models, image diagnosis, and the interpretation of histopathology findings. AI can support clinicians in decision-making, alleviate clinical burdens, and curtail healthcare expenses. In this review, we introduce the fundamental concepts of machine learning and review the role of AI in the management of chronic liver diseases.

Comparison of different diagnostic methods in infants for differentiating idiopathic neonatal hepatitis from biliary atresia

Background: Biliary atresia (BA) and idiopathic neonatal hepatitis (INH) are two most common etiologies of neonatal cholestatic jaundice. It is important to distinguish INH from BA biliary atresia in an infant. The study was conducted to compare of different diagnostic methods in infants in differentiating INH and BA. Methods: This cross-sectional study was conducted at the Department of Pediatric Gastroenterology & Nutrition, BSMMU during the period from July 2018 to June 2019 among infants with neonatal cholestasis. Total 50 cholestatitic cases were selected through purposive sampling. A thorough history and physical examination were done and liver enzymes were studied. Abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy were done in all cases. Clinical parameter and investigational sensitivity, specificity, and diagnostic precision were calculated. To diagnose BA and INH, liver biopsy was considered the gold standard. Results: Among the participants, 72% were diagnosed as BA and 28% were INH. More than half of patients were male. There exists significant difference of birth weight and term baby between BA and INH. Presence of persistent pale coloured stool was more commonly seen in patients with BA. Diagnostic accuracy of persistent pale coloured stool, birth weight (normal) and term baby were 94%, 92% & 88% respectively. Sensitivity and specificity of Gammaglutamyl transpeptidase (GGT) in differentiating cases with BA and INH with cut point of ≥430.0 U/L were 86.1% and 85.7%, respectively. Hepatobiliary scintigraphy is found to have a better sensitivity than ultrasonography. GGT had diagnostic accuracy 86%, hepatobiliary scintigraphy had diagnostic accuracy 88% & USG had diagnostic accuracy 80% for BA and INH. Conclusion: Among the studied clinical parameters persistent pale coloured stool was most accurate to suggest the presence of BA. Serum level of GGT at cut-off value ≥ 430 U/L may be used as a reliable laboratory parameter to differentiate INH and BA. Hepatobiliary scintigraphy found to have a good sensitivity for BA. Positive result of hepatobiliary scintigraphy may be used as BA in infants with cholestasis. JOPSOM 2023; 42(1):14-20

CD8 positive T-cells decrease neurogenesis and induce anxiety-like behaviour following hepatitis B vaccination.

Mounting evidence indicates the involvement of peripheral immunity in the regulation of brain function, influencing aspects such as neuronal development, emotion, and cognitive abilities. Previous studies from our laboratory have revealed that neonatal hepatitis B vaccination can downregulate hippocampal neurogenesis, synaptic plasticity and spatial learning memory. In the current post-epidemic era characterized by universal vaccination, understanding the impact of acquired immunity on neuronal function and neuropsychiatric disorders, along with exploring potential underlying mechanisms, becomes imperative. We employed hepatitis B vaccine-induced CD3 positive T cells in immunodeficient mice to investigate the key mechanisms through which T cell subsets modulate hippocampal neurogenesis and anxiety-like behaviours. Our data revealed that mice receiving hepatitis B vaccine-induced T cells exhibited heightened anxiety and decreased hippocampal cell proliferation compared to those receiving phosphate-buffered saline-T cells or wild-type mice. Importantly, these changes were predominantly mediated by infiltrated CD8+ T cells into the brain, rather than CD4+ T cells. Transcriptome profiling of CD8+ T cells unveiled that C-X-C motif chemokine receptor 6 positive (CXCR6+) CD8+ T cells were recruited into the brain through microglial and astrocyte-derived C-X-C motif chemokine ligand 16 (CXCL16). This recruitment process impaired neurogenesis and induced anxiety-like behaviour via tumour necrosis factor-α-dependent mechanisms. Our findings highlight the role of glial cell derived CXCL16 in mediating the recruitment of CXCR6+CD8+ T cell subsets into the brain. This mechanism represents a potential avenue for modulating hippocampal neurogenesis and emotion-related behaviours after hepatitis B vaccination.

Synthesis and Characterization of a Novel Modified Biosensor Carbon/Chitosan L-Leucine and Albumin Electrode for Bilirubin and Uric Acid Blood Detection

Bilirubin (BR) is a yellow-to-orange bile pigment produced by hemoglobin breakdown. It circulates in the blood, is absorbed by the liver, and then conjugated to form bilirubin diglucuronide. Its increased level in serum (Hyperbilirubinemia) may considered as an indication of certain diseases such as neonatal jaundice, hepatitis, and severe liver failure with cirrhosis. Thus, the monitoring of BR in plasma is clinically important. Herein, a novel carbon/chitosan paste electrode modified by L-leucine and Albumin (C/Chi-PL-BSA) is synthesized and tested for electrochemical sensitive determination of BR and Uric Acid. Significate sensitivity and important selectivity in the linear range of 1.00–150.00 μM for BR, and 10.00–600.00 μM for UA were obtained. Moreover, micromolar detection limits of 0.40 μM for BR and 1.00 μM for UA were achieved at pH13. The proposed oxidation mechanisms of BR and UA in alkaline media have been supported by DFT calculations at the B3LYP/ 6–31 G(d) level of theory. The easy preparation and high reproducibility made this electrode very appropriate in pharmaceutical preparations for the electrochemical determination of BR. Furthermore, Analyses using human serum were performed, demonstrating a high percentage of recovery.

Beyond the Rex: an innovative meso-intrahepatic portal vein bypass for late-onset extrahepatic portal vein occlusion after living donor liver transplantation.

The Meso-Rex bypass (MRB) is recognized as an effective treatment for portal hypertension secondary to extrahepatic portal vein occlusion (EHPVO) both in the pediatric and adult population, within or outside the context of liver transplantation. It is the preferred surgical treatment in most centers because not only does it addresses the portal hypertension, but also restores physiologic portal hepatopetal flow. However, the Rex recess, the landmark for this technique, may not be safely accessible in some patients. We present a 22-year-old male who underwent living donor liver transplant (LDLT) for neonatal hepatitis. He presented with variceal bleeding due to EHPVO at 13 years after transplant. Various endoscopic, radiologic, and surgical interventions were employed to address the recurrent gastrointestinal bleeding, but results have been unsatisfactory. We performed a meso-intrahepatic portal vein bypass (MIPVB), an innovative alternative to the MRB, for this patient with extensive post-operative adhesions, perihilar collaterals, and cavernous transformation. MIPVB creation in patients where the Rex recess is inaccessible is technically challenging. But with a multidisciplinary team approach, meticulous preoperative planning, and close follow-up, the authors have demonstrated that it is a safe and feasible option for patients with late-onset EHPVO after liver transplantation.

Patterns and unique features of infantile cholestasis among Arabs.

Most of the literature on infantile cholestasis (IC) originated from Caucasian and Asian populations. The differential diagnosis of IC is very broad, and identification of etiology is challenging to clinicians because the list includes many entities with overlapping clinical, biochemical, and histological features. Thus, a structured, stepwise diagnostic approach is required to help early recognition and prompt evaluation and management of treatable causes of cholestasis. (1) To determine the differential diagnosis of IC among Saudi population and (2) to evaluate the usefulness of a diagnostic algorithm that has been tailored by the authors to the local practice. All infants with onset of cholestasis before 12 months of age (2007 and 2020) were identified and included if they underwent extensive work up to exclude infectious, structural, metabolic, endocrine, infiltrative, and familial causes. Our diagnostic pathway allowed a definite diagnosis in 373 of the included 533 cases; 160 (30%) were labelled as "idiopathic neonatal hepatitis" (INH) [i.e., overall 70% detection rate]. However, when considering the cases that underwent extensive investigations including advanced gene testing (415 of the 533), the yield of the diagnostic algorithm was 90% (373/415). Familial cholestasis group was the most common in 20% (107/533), and biliary atresia and neonatal-onset Dubin Johnson syndrome contributed to 6% each. The genetic/hereditary causes of cholestasis contributed to 58% of the diagnosed cases (217/373). No single case of alpha-1 antitrypsin deficiency was diagnosed. Forty-nine infants with cholestasis presented with liver failure (9%). Our study highlights several unique features and causes of IC among Arabs which could have a great impact on the differential diagnosis process and the choice of laboratory tests used in the clinical setting.

DIFFERENCES OF BIRTH WEIGHT AND ONSET OF ACHOLIC STOOL BETWEEN EXTRAHEPATIC AND INTRAHEPATIC CHOLESTASIS

Background: Biliary atresia (extrahepatic cholestasis) and neonatal hepatitis (intrahepatic cholestasis) are two main causes of cholestasis. It is important to distinguish the type of cholestasis for determine management. Patient with intrahepatic cholestasis have birth weight lower than extrahepatic cholestasis. Onset of acholic stool in extrahepatic cholestasis usually appear in 15-30 days of first life. The aim of the study to identify differences of birth weight and onset of acholic stool between the type of cholestasis. Method: A retrospective study on cholestasis children aged under 2 years was conducted at Dr. Soetomo General Academic Hospital from January 2012 to December 2016. A thorough history of birth weight and onset of acholic stool were undertaken. Based on histopatology liver biopsy patients were classified into twogroups: I (extrahepatic cholestasis) and II (intrahepatic cholestasis). Result: Statistical analysis of Mann Whitney U was used with p<0.05 being significant. A total of 84 children were included, 55% were male. 40 children suffered from extrahepatic cholestasis (mean age 4.8 ± 2.6 months old) and 44 children suffered from intrahepatic cholestasis (mean age 2.9 ± SD 3.8 months old). The mean birth weight between extrahepatic and intrahepatic cholestasis were 2813 ± 704 gram vs 2717 ± 577 gram) (p=0.29). The mean onset of acholic stool between extrahepatic and intrahepatic cholestasis were 43.0 ± 60.6 days vs 26.6 ± 39.7 days (p=0.27). Conclusion : There is no difference of birth weight and onset of acholic stool between extrahepatic and intrahepatic cholestasis.

Primary Bile Acid Disorders: A Largely Unknown Group of Rare Genetic Diseases in Newborns

Primary bile acid disorders (BASD) in newborns are rarely found with a prevalence of 1-9/1,000,000 and include 1-2 % of all cases with neonatal cholestasis. Causes are different gene defects, which lead to liver enzyme defects, which play a major role in both cholic acid pathways, the classical with production of cholic acid and the alternative one with chenodeoxycholic acid. They are found in both genders in the same distribution. Early diagnosis is very important to introduce a bile acid replacement therapy as soon as possible as the treatment of choice to date. Diagnosis will be confirmed by molecular trsting, liver biopsy and different forms of mass spectrometry methods. Differential diagnosis includes progressive familial intrahepatic cholestasis, neonatal hepatitis and biliary atresia. Further gene therapy approaches must be developed, like CRISP Cas9 technology, to repair the spontaneous point mutations on DNA of these patients to cure and not to treat them their whole life finally.

Clinic-o-etiological profile of cholestasis in infants in a tertiary care center

Common presenting feature of hepatobiliary and metabolic dysfunction in neonates is cholestatic jaundice. It is essential to recognise the neonatal cholestasis early. Significant proportion of cases of cholestatic disease are constituted by EHBA. If management of Extra Hepatic Biliary Atresia is delayed beyond three months of life, only option available then is liver transplantation.To analyse etiological factors and to study clinical presentation of cases presenting with cholestasis.Study the clinical presentation and analyse the etiological factors in infants with cholestasis. To determine the validity of ACS and compare outcomes of EHBA with respect to age at presentation.Prospective observational study was done in 104 infants with cholestasis who were admitted in Paediatric ward of niloufer hospital from January 2019 to July 2020.Statistical analysis done by chi square test and fisher’s exact tests.Of the total 104 cases, 47 cases were diagnosed to be EHBA and 38 cases were found to have neonatal hepatitis.58.6% were male and 41.34%were female and 72 were term and 32 were preterm. Mean age of presentation with EHBA and Neonatal hepatitis was 91 days and 94 days. LFT’s in EHBA cases showed mean TSB 12.19 ± 5 mg/dl Vs 11.7 ± 5.8 mg/dl in NH babies with a p value equal to 0.379. Direct bilirubin revealed 6.44 ± 3.1mg/dl Vs 6.64 ± 3.1mg/dl in NH group (p = 0.824).HIDA scan showed 41% had EHBA, 33.3% had NH AIIMS Clinical score (ACS) cannot correctly differentiate EHBA from NH.Survival was significantly higher in infants with EHBA who were operated before 60 days of life.

Neonatal hepatitis B vaccination: Reevaluating timing and adjuvants for enhanced safety and effectiveness

AbstractOur aim is an achievement of a 100 percent vaccination rate without toxic vaccine effects. We did a comprehensive literature review on aluminum neurotoxicity and early neonatal hepatitis B vaccination. We analyzed indications for introduction of early neonatal hepatitis B vaccination and the data on experimental and clinical aluminum‐induced neurotoxicity. It is justified very early hepatitis B vaccination to be carried out in high‐risk endemic areas. In those countries there is a large number of hepatitis B positive individuals, including pregnant women, which leads to a great number of vertical, mother‐to‐child, transmissions of the virus during pregnancy. There is also a serious risk of perinatal Hepatitis B virus infections in such countries. Early neonatal hepatitis B vaccination is also carried out in low‐risk countries, where the number of hepatitis B positive pregnant women is extremely small, making the number of newborns who require the prevention of hepatitis B infection extremely small as well. It is necessary for all vaccines which contain aluminum as an adjuvant to be immediately suspended as children vaccination until they start walking and until aluminum is replaced with calcium, zinc or a nonmetallic adjuvant such as microcrystalline tyrosine or monosodium urate. Meanwhile sustained efforts should be made to create the so‐called mucosal vaccines against diphtheria, pertussis, measles, mumps and rubella. At the same time, all the children born to hepatitis B positive mothers, regardless of their place of birth must be vaccinated against hepatitis B as the benefits from vaccines by far outweigh potential harm caused by adjuvant aluminum.

Percutaneous Ultrasound Cholangiography With Microbubbles in Children With Biliary Diseases.

The application of intracavity contrast-enhanced ultrasound in the evaluation of biliary disease has been confirmed valuable among pediatric population. This pictorial essay aims to demonstrate the role of percutaneous ultrasound cholangiography (PUSC) with microbubbles in the diagnosis of different pediatric biliary diseases in our center. The biliary system's morphologic characteristics in PUSC mode of neonatal hepatitis, biliary atresia, choledochal cysts, and biliary complications of hepatobiliary surgery are presented.

The seroepidemiology of isolated core antibody against hepatitis B among Taiwanese adults - A large hospital-based study

This study aims to investigate the prevalence of isolated core antibodies against hepatitis B (IAHBc) in different birth cohorts using a large medical record database. Hepatitis B viral serological test data were collected from a chart cloud database at a medical center in Taiwan between January 2006 and December 2018. The data collected included birth year, sex, hepatitis B viral markers (HBsAg, anti-HBs or anti-HBc), and hepatitis B vaccination records. Enrolled patients were grouped according to their birth year into three categories:≤1986, 1987-1992, and≥1993, which correspond to no neonatal hepatitis B immunization, plasma-derived HB vaccine (PDHBV), and recombinant hepatitis B vaccine (RHBV), respectively. Prevalence of hepatitis B viral seromarkers, including IAHBc, was calculated by sex, age groups, and birth cohorts. Those who underwent repeated hepatitis B serology tests were included for further analysis to follow up their serostatus. A total of 117,335 adults with complete hepatitis B serologic data were analyzed. Among them, 6641 individuals (5.7%) were found to have IAHBc. The prevalence of IAHBc was 11.4%, 0.8%, and 0.3% among those born before 1986, between 1987 and 1992, and after 1992, respectively. Among the 690 subjects with repeated blood tests and complete hepatitis B serologic data, 551 cases (79.9%) remained IAHBc. The other cases included resolved infection status (13.9%), seronegativity for three HB seromarkers (3%), and carrier of hepatitis B virus (2.3%). The management of individuals with IAHBc should be tailored to their age, vaccination status, and risk factors for occult hepatitis B viral infection.

An Insight Into Neonatal Cholestasis; A Tertiary Care Hospital Experience in Rawalpindi, Pakistan

Objective: To determine the frequencies of various etiologies of neonatal cholestasis diagnosed by clinical findings and laboratory investigations at the Pak Emirates Military Hospital, Rawalpindi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Pediatric Department of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan 2021 to Apr 2022. Methodology: Infants of either gender aged 14 days to six months admitted to Inpatient facility who had jaundice with direct bilirubin and more than 20% of total bilirubin were included in the study. The proforma was formulated to record the clinical features, laboratory investigations, weight, level of activity and consanguinity among the parents. Results: A total of 146 infants were included in the study. Jaundice was seen in 100% of infants, hepatomegaly in 66.4%, splenomegaly in 38.4%, followed by ascites in 25%. The most common aetiology of neonatal cholestasis was Biliary Atresia 26.7% in the extrahepatic Group, Idiopathic Neonatal Hepatitis 25.3% in the intrahepatic Group. Consanguinity was present in parents of 65% of infants. Conclusion: The most common aetiology of extrahepatic Neonatal Cholestasis was Biliary Atresia, while Idiopathic Neonatal Hepatitis and Progressive Familial Intrahepatic Cholestasis were the most common causes of intrahepatic cholestasis.

Diagnostic Accuracy of Cord Blood Bilirubin in Predicting Neonatal Hyperbilirubinemia, Taking Neonatal Hyperbilirubinemia within One Week of Birth as Gold Standard

Objective: To determine the diagnostic accuracy of cord blood bilirubin in predicting neonatalhyperbilirubinemia, taking neonatal hyperbilirubinemia within one week of birth as the gold standard.Study Design: Across-sectional study.Place and Duration of Study: The Study was conducted at the Department of Pediatric Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan from 7 September 2020 to 6 March 2021.Methods: A total of 366 term neonates of both gendersgenders were included. Neonates with congenital hypothyroidism, neonatal hepatitis, biliary atresia, and sepsis were excluded. After getting informed consent from parents, a cord blood sample was taken and sent to the institutional laboratory for measuring total bilirubin levels, and neonatal hyperbilirubinemia (yes/no) was noted. All neonates were followed by the researcher for one week and neonatal hyperbilirubinemia was noted.Results: The study yielded 193 true positive and 14 false positive cases, along with 7 false negative and 152 true negative cases, with a statistically significant p-value of 0.0001. Overall, the diagnostic accuracy of cord blood bilirubin in predicting neonatal hyperbilirubinemia, using neonatal hyperbilirubinemia within one week of birth as the gold standard, was found to be 96.50% for sensitivity, 91.57% for specificity, 93.24% for positive predictive value, 95.60% for negative predictive value, and 94.26% for diagnostic accuracy.Conclusion: This study has shown that cord blood bilirubin has a rather good diagnostic accuracy for predicting newborn hyperbilirubinemia.
 How to cite this: Majeed M, Ahmed D, Hanif D, Khaliq H, Ahmad A, Khan ZA. Diagnostic Accuracy of Cord Blood Bilirubin in Predicting Neonatal Hyperbilirubinemia, Taking Neonatal Hyperbilirubinemia within One Week of Birth as Gold Standard. Life and Science. 2023; 4(4): 401-409. doi: http://doi.org/10.37185/LnS.1.1.347

Acute murine cytomegalovirus infection boosts cell-type specific response and lipid metabolism changes in the liver of infant mice.

Human cytomegalovirus (HCMV) infection in infants can lead to severe diseases, including neonatal hepatitis. The single-cell dimensional changes in immune cells after the initial CMV infection remain elusive, as do the effects of CMV infection on hepatic lipid metabolism. We employed single-cell RNA-sequencing to investigate the changes in liver cell types and immune responses in infant mice following murine CMV (MCMV) infection. Additionally, we examined alterations in protein expression profiles related to lipid metabolism in hepatocytes and the role of the key transcription factor PPAR-γ in hepatocytes during CMV infection. Our study revealed that MCMV infects most liver cell types in infant mice, leading to an increase in the proportion of proliferating CD8 effector T cells and a subset of Nos2+ monocytes, potentially playing an essential role in early anti-viral responses. Furthermore, MCMV infection resulted in altered protein expression of lipid metabolism in hepatocytes. Knocking down the transcription factor PPAR-γ in hepatocytes effectively inhibited CMV infection. Our findings underscore the immune system's response to early-stage MCMV infection and the subsequent impact on hepatic lipid metabolism in infant mice. This research provides new insights into the mechanisms of CMV infection and could pave the way for novel therapeutic strategies.

First hepatitis B vaccine uptake in neonates prior to and during the COVID-19 pandemic.

Routine vaccination for hepatitis B is recommended at birth, and most infants should be vaccinated within 24h of life. Historically, vaccination rates have been less than ideal, and routine vaccination has been further complicated by the COVID-19 pandemic, with decreased uptake of many vaccines. This retrospective study assessed hepatitis B vaccination rates at birth before and after the start of the COVID-19 pandemic and explored the factors associated with lower vaccination rates. Infants born at a single academic medical center in Charleston, South Carolina from November 1, 2018 through June 30, 2021 were identified. Infants were excluded if they died or received≥7days of systemic steroid therapy within the first 37days of life. Maternal and infant baseline characteristics and uptake of the first hepatitis B vaccine during hospital admission were recorded. A total of 7808 infants were included in the final analysis, with an overall vaccine uptake of 91.6%. Of the 3880 neonates in the pre-pandemic group, 3583 (92.3%) were vaccinated, versus 3571 (90.9%) of 3928 neonates in the pandemic group (rate difference=1.4%; 95% confidence interval -2.8% to 5.7%, p=0.52). Factors independently associated with lower vaccine uptake included being of non-Hispanic white race, born to a married mother, birth weight<2kg, and parental refusal of erythromycin eye ointment at birth. The COVID-19 pandemic did not significantly affect the uptake of inpatient neonatal hepatitis B vaccination. Several patient-specific factors were associated with suboptimal vaccination rates in this population.

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya.

In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program. A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web-based survey. A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1-5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192-570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT. In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals.

Therapeutics for fulminant hepatitis caused by enteroviruses in neonates.

Neonatal infection with nonpolio enteroviruses (EVs) causes nonspecific febrile illnesses and even life-threatening multiorgan failure. Hepatitis, which often results in hepatic necrosis followed by disseminated intravascular coagulopathy, is one of the most severe and frequent fatal neonatal EV infection complications. Coxsackievirus B (CVB) 1-5 and many echoviruses have been most commonly identified. Neonatal EV infection treatment has usually involved initial supportive care. Studies for CVB and echovirus infection treatments were developed for more than thirty years. Intravenous immunoglobulin and pleconaril therapy was performed in some clinical trials. Additionally, other studies demonstrated antiviral and/or anti-inflammatory pathogenesis mechanisms of neonatal EV hepatitis in in vitro or in vivo models. These treatments represented promising options for the clinical practice of neonatal EV hepatitis. However, further investigation is needed to elucidate the whole therapeutic potential and safety problems.

Clinical and laboratory evaluation of cholestatic jaundice in a sample of Iraqi infants

Cholestatic jaundice most probably occurs due to a pathological condition moreover difficult diagnostic problem. The aim of the study: to determine the etiology of cholestatic jaundice in infancy and to evaluate if clinical events and different investigations could assist in the differential diagnosis of intra and extra-hepatic cholestasis. In this hospital-based study analysis of 35 cases diagnosed with cholestatic jaundice aged 3 weeks up to 12 months from two centers carried out from January 2018 to July 2018. Clinical, biochemical, radiological, histopathological results were recorded. Results: Regarding the 35 patients were (54.3% males, 45.7% females), the mean age at presentation was 117.9 ± 86.4 days and mean age at onset of jaundice was 34 ± 59.11 days, All patients were presented with jaundice (100%) and (45.7%) of them were presented with clay color stool, (77.1%) of patients presented with hepatomegaly followed by ( 54.3%) with splenomegaly, regarding the etiology of cholestasis, Extrahepatic biliary atresia was the commonest cause (22.9%) and the most common cause of intrahepatic etiology was Cytomegalovirus (14.3%). While Idiopathic neonatal hepatitis, Alagille syndrome were (8.6%) for each. Progressive familial intrahepatic cholestasis, Galactosemia, Tyrosinemia, and septicemia were (5.7%) for each. Congenital rubella and congenital hypothyroidism and Fatty acid oxidation disorder were (2.9%) for each. Undiagnosed patients represented (14.3%) of all cases. Inconclusion, the etiologies of infantile cholestatic jaundice are numerous. and was no single laboratory investigation that could precisely make a definite diagnosis. Extrahepatic biliary atresia was the most common cause of cholestasis in this study. Jaundice, hepatomegaly, and pale stools were the common clinical features on presentation.