Neonatal hepatitis: clinico-pathologic study with an attempt to set a histologic activity prognostic index

ABSTRACT

Neonatal hepatitis encompasses a variety of cholestatic disorders having different underlying etiologies with varied prognoses. The aim of this work is to do a clinico-pathologic study of neonatal hepatitis cases with an attempt to set a histological activity index that might give an idea about the possible outcome of the disease irrespective of the underlying etiology. The study included 36 neonatal hepatitis patients who presented to Pediatric Hepatology unit Cairo University Children's Hospital. Analysis of data included thorough history, clinical examination, laboratory findings, liver biopsies and follow up. A scheme was proposed for grading the histological activity in liver biopsy done at presentation using lobular disarray, giant cell tans formation, cholestasis, portal tract mononuclear inflammatory cellular infiltrate, Kupffer cell hyperplasia, porto-portal necroinflammatory bridging and extramedullary hematopoiesis. Staging was based on the degree of fibrosis. Twenty cases showed complete cure by clinical and laboratory follow up findings; [Group with favorable outcome], whereas 16 cases either died or severely deteriorated during follow up; [Group with unfavorable outcome]. At the onset of the disease, there was no statistically significant difference in the clinical picture and laboratory findings between the group with favorable outcome and the group with the unfavorable outcome. Kupffer call hyperplasia was statistically significantly higher in the group with favorable outcome than in the group with unfavorable outcome. Other histologic parameters did not show statistically significant difference, between the two groups. Findings in this study revealed that Kupffer cell hyperplasia, by Logistic Regression Analysis; is the only predictor for improvement of neonatal hepatitis. Other parameters used in this study did not show statistically significant difference between the two groups. Further studies to determine the exact cytokines secreted by the Kupffer cells might provide more insight into the pathogenesis, prognosis and possible future therapeutic intervention