Chronic hepatitis B infection: long term comparison of children receiving interferon alpha and untreated controls.

OBJECTIVES: To investigate the virological outcome of chronic hepatitis B (CH-B) in children who received interferon alpha (IFN) compared with no treatment. METHODS: Seventy-four children with CH-B (median age, 6.1 years; 44 boys) selected from a cohort of 158 cases were included and divided into two groups: IFN-treated (n = 37) and control (n = 37). The controls were matched with the treated children by baseline alanine aminotransferase (ALT) levels, sex and age. The Kaplan-Meier method was performed to estimate the time to clearance of hepatitis B e antigen (HbeAg) and hepatitis B surface antigen (HbsAg). RESULTS: Mean duration of follow-up was comparable in two groups (5.2 +/- 3.8 years in treatment group versus 5.2 +/- 3.7 years in control group, NS). HBeAg and HBsAg loss occurred in 20 (54.1%) and three treated children versus 13 (35.1%) and one untreated children (NS), respectively. The 7-year cumulative HBeAg and HBsAg clearance rates were 47.5% and 8.9% after the first visit in the treatment group versus 33.5% and 4.0% in untreated children (NS), respectively. Elevated baseline ALT (two times upper limit of normal) had a significant effect on the long-term cumulative rate of HBeAg seroconversion in treated patients (P = 0.01) but not in the untreated group. CONCLUSIONS: These findings show that the overall long-term virological outcome does not differ significantly between IFN-treated and untreated children but that a significant benefit of treatment on the long term rate of HBeAg seroconversion is obtained in children with higher baseline ALT levels.

A case of hepatopulmonary syndrome in a child with cirrhotic portal hypertension

Report a case of 4 years old girl lived in Gia Lai province, admitted Hospital of Pediatrics No 2 at December 6th 2004. 3 days before admitting hospital, she had some symptoms including hemorrhagic vomiting, melena, and then was admitted Gia Lai Hospital. She was diagnosed with upper digestive hemorrhage, and treated by hypodermoclysis and fresh blood transfusion. Hemogram test discovered anemia. Pulmonary X ray had no abnormal image. Abdominal color Doppler ultrasound revealed images of cirrhosis and portal hypertension, large spleen. The spiral chest CT scan found that no abnormal pulmonary vessel. Patient was treated by endoscopic sclerosis of esophageal varices, and administration of Axepim and gentamycine based on antibiotic susceptibility test. Results of microbiological test after treatment was negative