bubble_chart Overview

Neonatal hepatitis syndrome is a newborn disease caused by various factors, with the main pathological feature being the formation of nonspecific multinucleated giant cells. Its primary manifestation is jaundice, and the prognosis is generally favorable. Most cases are caused by infections during or after delivery, while a few are associated with congenital metabolic defects. The cause of the disease remains unknown in some cases.

bubble_chart Etiology

Neonatal hepatitis syndrome includes hepatitis caused by hepatitis B virus, cytomegalovirus, herpes simplex virus, Coxsackie virus, and rubella virus, as well as infections by ECHO virus, EB virus, Toxoplasma, Listeria, or various bacteria. These pathogens can infect the fetus through the placenta or during childbirth or after delivery. A small number of cases are related to congenital metabolic defects. The cause of the disease in some cases remains unknown.

bubble_chart Pathological Changes

Although the causes of the disease are numerous, the primary pathological change is the formation of nonspecific multinucleated giant cells. Bile stasis occurs, with inflammatory cell infiltration in the hepatic interstitium and portal areas, the extent of which correlates with the severity of the condition. In mild cases, the liver lobule structure remains normal, while severe cases may exhibit disorganization. Hepatocytes show focal or patchy necrosis, with Kupffer cell and small bile duct proliferation. Chronic cases may develop periportal fibrosis. A characteristic feature of cytomegalovirus infection is the presence of owl's eye-like intranuclear inclusions in affected cells.

bubble_chart Clinical Manifestations

The main manifestation is jaundice. Patients often seek medical attention due to persistent physiological jaundice or recurrence after subsiding. Other symptoms such as low-grade fever, vomiting, abdominal distension, and fullness may also occur. Physical examination reveals hepatosplenomegaly, dark urine, and stools that change from yellow to light yellow or even white. In most cases, jaundice gradually subsides within 3 to 4 months, but complications such as dry eye disease, hypocalcemic spasms, bleeding, and diarrhea may occur. A small number of severe cases with prolonged disease progression may lead to cirrhosis and liver failure. Laboratory tests show that total bilirubin is generally below 171 μmol/L (10 mg/dl), with both conjugated and unconjugated bilirubin elevated, predominantly the former. Alanine aminotransferase (ALT) levels may be elevated or normal. Alpha-fetoprotein (AFP) in newborns should turn negative after one month of age, but in patients, it may remain elevated, indicating increased hepatocyte destruction and regeneration. AFP typically peaks about one week after the ALT peak, while serum alkaline phosphatase remains normal.

bubble_chart Diagnosis

The diagnosis of neonatal hepatitis syndrome is relatively difficult. Among infants born to mothers who are positive for hepatitis B surface antigen (HBsAg), 20–50% become HBsAg carriers within the first six months of life, but most are asymptomatic. The chance of mother-to-child transmission of hepatitis B virus is much higher during delivery through the birth canal than during intrauterine transmission. In a study of 80 infants with the syndrome, the Second Affiliated Hospital of China Medical University isolated viruses from urine and measured serum IgM antibodies in some cases, confirming 12 cases as cytomegalovirus hepatitis. In another study at the Xinjiang Autonomous Region Hospital, half of the 16 cases of neonatal hepatitis showed cytomegalic inclusion bodies in urinary exfoliated cells. Jaundice caused by neonatal sepsis may yield positive blood cultures. Additionally, there are cases of neonatal jaundice disease with unknown causes.

This condition is sometimes difficult to differentiate from neonatal congenital biliary atresia. However, misdiagnosing neonatal hepatitis as biliary atresia and performing surgery can worsen the condition. The differential diagnosis between these two diseases is discussed in the section on biliary atresia below.

bubble_chart Treatment Measures

Chinese medicinals Virgate Wormwood and Sanhuang Decoction (see the comprehensive treatment for neonatal jaundice above) can be taken long-term. For severe cases, injections can be used once or twice daily. Short-term use of adrenal corticosteroids may help alleviate jaundice. Additionally, liver-protective therapy can be administered following the principles of integrated traditional Chinese and Western medicine for acute hepatitis A.

bubble_chart Prognosis

The prognosis is relatively good, with 60-70% of cases being curable. Fewer cases progress to cirrhosis or death. According to a 10-year observation by Xinhua Hospital affiliated with Shanghai Second Medical College (including biliary atresia), the mortality rate was 13%. Recent reports indicate that the hepatitis B vaccine can effectively prevent mother-to-child transmission.