Characterization and outcomes of young infants with acute liver failure.

Abstract

OBJECTIVE:

To characterize infants aged ≤ 90 days enrolled in an international, multicenter, prospective registry of children aged < 18 years with acute liver failure (ALF).

STUDY DESIGN:

The Pediatric Acute Liver Failure (PALF) Study Group collects prospective data on children from birth to 18 years. We analyzed data from infants aged ≤ 90 days enrolled in the PALF Study before May 18, 2009.

RESULTS:

A total of 148 infants were identified in the PALF registry (median age, 18 days). Common etiologies of ALF were indeterminate (38%), neonatal hemochromatosis (13.6%), and herpes simplex virus (12.8%). Spontaneous survival occurred in 60% of the infants, 16% underwent liver transplantation, and 24% died without undergoing liver trsansplantation. Infants with indeterminate ALF were more likely to undergo liver transplantation than those with viral-induced ALF (P = .0002). The cumulative incidence of death without liver transplantation was higher in infants with viral ALF (64%) compared with those with neonatal hemochromatosis (16%) or indeterminate ALF (14%) (P = .0007).

CONCLUSION:

ALF in young infants presents unique diagnostic considerations. Spontaneous survival is better than previously thought. Liver transplantation provides an additional option for care.

• Authors: Shikha S Sundaram, Estella M Alonso, Michael R Narkewicz, Song Zhang, Robert H Squires, Pediatric Acute Liver Failure Study Group
• Journal: The Journal of pediatrics (J Pediatr) Vol. 159 Issue 5 Pg. 813-818.e1 (Nov 2011) ISSN: 1097-6833 [Electronic] United States
• PMID: 21621221 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Mosby, Inc. All rights reserved.

Chemical References

• gamma-Glutamyltransferase
• Aspartate Aminotransferases
• Alanine Transaminase

Topics

• Alanine Transaminase (blood)
• Aspartate Aminotransferases (blood)
• Cholestasis (epidemiology)
• Hemochromatosis (congenital, epidemiology)
• Hepatic Encephalopathy (epidemiology)
• Herpes Simplex (epidemiology)
• Humans
• Hyperbilirubinemia (epidemiology)
• Infant
• Infant, Newborn
• International Normalized Ratio
• Liver Failure, Acute (etiology, mortality, surgery)
• Liver Transplantation (statistics & numerical data)
• Prospective Studies
• Registries
• gamma-Glutamyltransferase (blood)