Today, the prevalence of hepatitis is growing significantly. It covers various segments of the population: from early childhood to the elderly. In addition, today such pathology as congenital or fetal hepatitis often began to appear, which will be discussed in this article.
What does it mean and what is dangerous?
Congenital hepatitis is an acute pathology of a viral nature that occurs during intrauterine development of the fetus or develops in the first months of a child’s life (1-2 months). It is characterized by rapid damage to the liver cells of the fetus or newborn.
There are several main forms of fetal hepatitis that affects the liver in the womb – hepatitis B, C, less often cases of infection with hepatitis A, D and E. Infection with the disease can occur from the 16th week of the prenatal period, when the main development of all organs and systems occurs.
This disease occurs when it is infected through the blood serum, through the placenta, therefore these pathologies are very dangerous and carry a great risk for the future life of the newborn. This is due to a severe clinical course, a rapid increase in symptoms that pose a danger to the life of a small patient.
In addition, if the infection occurred through the placenta from the mother of the child, there is a considerable risk of developing abnormalities in the structure of the liver, complete failure of the organ.
To answer the question why babies develop such a dangerous pathology as congenital hepatitis, it is necessary to know and take into account all the risk factors and causes that can cause this pathology.
The main reason for the infection of the fetus or infant with viruses in the early or late neonatal period is the ingress of a pathological agent into the bloodstream of the baby.
This can happen in various ways:
- When the virus passes through the placental barrier, it most often occurs in early pregnancy or in the third trimester of pregnancy, with hepatitis-positive blood in the mother.
- Infection when passing through the birth canal of a sick mother.
- Blood transfusion for a baby from an unverified donor.
- Violation of the rules of asepsis and antiseptics when processing the baby’s umbilical cord, when carrying out manipulations that require damage to the baby’s skin.
In addition, congenital hepatitis in children, or liver damage can occur if a woman did not avoid drinking alcohol and tobacco during pregnancy, if she suffered from diseases such as:
- Severe ARVI and flu.
- Skin and venereal diseases.
Hepatitis in newborns, the causes of which can be very diverse, can occur in various forms of severity, against the background of developing sepsis, depending on the degree of damage to the liver of the baby, on the type of ailment.
Types of hepatitis in newborns
Viral hepatitis in newborns has several types of course, which are caused by the causes and factors that caused this pathology. Today, there are several main types:
- Hepatitis B – today a fairly frequent occurrence of this hepatitis in newborns has been recorded. Most often it turns into a chronic form of the course, which is due to the constant presence of a viral agent in the baby’s blood. Most often, this type is transmitted through the placenta or during the passage of the fetus through the birth canal.
- Hepatitis C of viral etiology – the appearance of this type in newborns is due to the same reasons as viral hepatitis B. However, this type has a slower course with a long absence of manifestations of pathology. According to the latest data, infants are infected with hepatitis C in 5% of cases.
- Hepatitis A – this type has a fecal-oral route of penetration to the newborn. It manifests itself very rarely, in case of violation of the rules of catering in the hospital, therefore today there are practically no cases of congenital morbidity with this pathology, as well as the case of hepatitis D and E.
Fetal hepatitis in newborn babies requires immediate medical attention to the infant to prevent complications.
Neonatal hepatitis is one of the varieties of fetal hepatitis, inflammation of the liver tissue that occurs in the early (up to 7 days after birth) or late neonatal period (8-28 days).
The main manifestations of neonatal hepatitis occur in the first weeks after the birth of a child and are detected when a neonatologist conducts a comprehensive examination of the infant. Depending on the type of pathogen, it can manifest itself as various foci of liver damage, have a different severity of the course.
Most often, neonatal hepatitis manifests itself in the same way as generalized infection – sepsis. In addition, in the case of infection with hepatitis B or C, there is a high risk of asymptomatic clinical presentation of the disease. The neonatal form is characterized by a protracted course of the icteric stage of the disease.
Despite the different types of congenital ailment in children, the symptoms have a similar clinical picture based on liver damage. However, there is a different degree and form of severity of this disease in newborns:
- Anicteric – this stage is characterized by the appearance of lethargy and weakness of the child, the refusal of the newborn from food, the baby is pale. In addition, when a complete examination is performed, there is an increase in liver and spleen segments.
- Preicteric is the stage of transition from one form to another, characterized by an increase in all manifestations of anicteric form, lasts from several hours to several days. At the same time, the baby does not sleep, spits up all the food – the appearance of symptoms of dehydration of the baby is characteristic, he may have a slight body temperature. For this stage, darkening of urine, clarification of feces is also characteristic.
- Jaundice is the stage of all clinical manifestations of the disease, which is characterized by: high fever, the baby is lethargic, does not eat, the appearance of jaundice. On the part of the organs of the gastrointestinal tract, a malfunction appears – the stool becomes liquid, frequent. The skin and mucous membranes become jaundiced. Often with this form, signs of hepatic encephalopathy begin to develop, damage to the nervous system of the baby.
If at least one symptom appears, the child should be urgently hospitalized in the intensive care unit, where he will be fully examined and treated.
If there was an intrauterine infection with a pathology or there was a risk of this disease, then immediately after the birth of the child, they are sent for examination. The basis of diagnostic procedures is the examination of the newborn – examination, percussion, palpation, the use of laboratory and additional diagnostic methods.
Laboratory studies carry the most significant characteristics and provide basic concepts of the presence of the disease, include:
- General blood test – reveals a decrease in the leukocyte mass in the baby’s bloodstream.
- General urine analysis – in the presence of an icteric stage, urobilin and bile pigments appear in the urine.
- Coagulogram – is prescribed to determine fibrinogen and reduce the level of blood clotting of the patient.
- Blood biochemistry – hepatitis is characterized by an increase in the level of direct bilirubin, ALT and AST segments.
- Serological examinations – allow detecting hepatitis antibodies of a certain group in the baby’s blood.
- PCR – diagnostics.
Additional diagnostic methods include ultrasound of the abdominal organs, which allows to identify the state of the liver and spleen, other organs in the presence of a disease, liver biopsy to determine the lesions and identify the type of disease.
It is important to assess the need to differentiate the disease with other pathologies of childhood – galactosemia, intrahepatic cholestasis, congenital hemolytic anemia.
Treatment for hepatitis in newborns should begin as soon as possible after detection. The main therapeutic measures in this case will be aimed at restoring baby liver cells, depending on the type and stage of pathology. This will avoid negative consequences and complications.
Unfortunately, today there are no special methods of treating the disease in newborns. Therefore, supportive care is the main principle.
So, the main principle of therapeutic measures for acute fetal hepatitis will be the appointment of hepatoprotectors (Karsil, Gepabene, Essentiale) and antiviral agents (most often, the use of Viferon is shown to newborns).
The purpose of these funds is based on the weight of the baby and should be strictly controlled by a neonatologist and pediatrician.
In addition, an important component of treatment is diet therapy for the mother of the child, if the baby is breastfeeding – the complete elimination of fatty, fried foods, allergens – citrus fruits, nuts, products containing flavor enhancers and dyes. In some cases, they switch to artificial feeding with the help of vitamin-containing mixtures.
It is important to carry out dehydration therapy – for this, infusion solutions are prescribed to the baby to increase the amount of fluid. The introduction of vitamin K is shown – to improve blood clotting.
Often the therapy of the disease does not give good results – this is due to the latent course of many signs of the disease in newborns, the rapid effect of the disease. The consequences of congenital pathology can affect not only the digestive tract, but also the entire body of the child as a whole, on which the prognosis of the disease depends:
- Transition to the chronic stage.
- Cirrhosis of the liver.
- Increased pressure in the portal hepatic veins and arteries.
- Rickets, osteoporosis, hypovitaminosis K and E.
- Hepatic encephalopathy.
- Delayed infant development.
- Acute renal and hepatic failure.
These complications can be avoided only if timely diagnose and start therapeutic measures aimed at maintaining the viability of the infant’s liver. In some cases, the rapid course of fetal hepatitis can lead to the death of the infant.
Prophylaxis and prognosis
Congenital hepatitis can be prevented – for this, all preventive measures must be followed. Thus, every pregnant woman is examined for hepatitis, toxoplasmosis and rubella during pregnancy.
An important criterion for the prevention of ailment in newborns is the threefold vaccine prophylaxis of the infant, carried out in the first months of the baby’s life.
The prognosis of the disease depends on the stage and type of the disease, the presence of complications – so, today there is a high probability of a positive outcome of congenital ailment in children. The mortality rate of newborns from this pathology is on average 2-5%.
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