Hepatitis B Virus (Hbv) Infection In Newborns

The neonatal hepatitis B virus infection is usually transmitted during childbirth. It is usually asymptomatic, but can cause a subclinical chronic disease in later childhood or adulthood. Symptomatic infections cause jaundice, lethargy, failure to thrive, a strained abdomen and tonfarbene chairs. The diagnosis is made serologically. A severe course in rare cases, liver failure and may require a liver transplant. Less severe cases are treated only supportive. Active and passive immunization prevent vertical transmission.

The neonatal hepatitis B virus infection is usually transmitted during childbirth. It is usually asymptomatic, but can cause a subclinical chronic disease in later childhood or adulthood. Symptomatic infections cause jaundice, lethargy, failure to thrive, a strained abdomen and tonfarbene chairs. The diagnosis is made serologically. A severe course in rare cases, liver failure and may require a liver transplant. Less severe cases are treated only supportive. Active and passive immunization prevent vertical transmission.

(Acute viral hepatitis at a glance.) The neonatal hepatitis B virus infection is usually transmitted during childbirth. It is usually asymptomatic, but can cause a subclinical chronic disease in later childhood or adulthood. Symptomatic infections cause jaundice, lethargy, failure to thrive, a strained abdomen and tonfarbene chairs. The diagnosis is made serologically. A severe course in rare cases, liver failure and may require a liver transplant. Less severe cases are treated only supportive. Active and passive immunization prevent vertical transmission. Of the known viral hepatitis only hepatitis B (HBV) is regarded as the cause of neonatal hepatitis. Other viral infections (cytomegalovirus, herpes simplex virus) can cause liver inflammation along with other symptoms. Etiology At birth is transmitted HBV infection from an infected mother to the newborn. The risk of transmission is located at 70-90% in women who were seropositive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg Acute viral hepatitis include: serology) are at the time of delivery. Women without e-antigen or anti-HBe transmit the infection only 5-20% of cases. A transfer of HBV from mother to the newborn occurs primarily via maternofetale micro transfusions during the second stage, or by contact with infectious secretions in the birth canal. Transplacental transmission is identified in <2% of infections. More rarely there is a postpartum infection through contact with maternal blood, saliva, urine or mother's milk. Up to 90% of children infected perinatally, develop a chronic infection and perinatally acquired HBV infection can be an important viral reservoir in certain environments. Symptoms and complaints The vast majority of newborns with HBV infection is asymptomatic, but developed a chronic subclinical infection that is characterized by a persistent HBs antigenemia and a partly elevated transaminase. Many newborns of mothers with acute hepatitis B during pregnancy have regardless of whether they themselves are ill or not, a low birth weight. Rarely infected newborns develop acute hepatitis B, which then runs mild or self-limiting. It manifests itself with jaundice, lethargy, failure to thrive, a strained abdomen and clay-colored stools. Sometimes a severe infection with hepatomegaly, ascites, and hyperbilirubinemia (predominantly conjugated bilirubin) occurs. Very rarely, the course is fulminant or fatal. Severe progressive forms are more frequently observed in children whose mothers are chronic hepatitis B carriers. Diagnostic tests Serological diagnosis of neonatal HBV infection is provided by serological tests, including measurement of HBsAg, HBeAg, antibodies against the hepatitis B e antigen (Anti-HBe) and a quantification of HBV DNA in the blood. Other initial tests include a blood count with platelet, alanine aminotransferase (ALT) and ?-fetoprotein levels and liver ultrasonography. A possible family history of liver cancer or liver disease is an important indicator because of the long-term risk of hepatocellular carcinoma. If the test suggests HBV infection, the consultation is recommended with a pediatric hepatologist. Prognosis The long-term prognosis is not predictable; although it seems that chronic infection with HBV at an early age with increased risk for the development of liver injury associated therewith chronic hepatitis, cirrhosis, liver terminal disease and hepatocellular carcinoma. Treatment Supportive treatment Symptomatic treatment and appropriate diet are advisable. Neither corticosteroids nor hepatitis B immune globulin (HBIG) is useful for an acute infection. No treatment prevents the development of chronic, subclinical hepatitis, if the infection was first acquired once. All children with chronic HBV infection should be immunized with hepatitis A vaccine. Children with chronic HBV infection can of antiviral drugs (eg., Interferon alfa, lamivudine, adefovir) benefit, but these should only be used in consultation with a pediatric hepatologist. Prevention Pregnant women should be routinely tested in early pregnancy for HBsAg. If this is not possible, the examination should be performed when recording for childbirth. Some women who are HBsAg positive are treated in the third trimester with lamivudine or telbivudine, which can prevent perinatal transmission of HBV. Infants whose mothers are HBsAg positive should with 0.5 ml of HBIG i.m. within 12 h are inoculated after birth. Recombinant HBV vaccine i.m. administered in a series of three doses, is recommended for all children in the United States. (Note: doses vary from one manufacturer.) The first vaccination is administered simultaneously with HBIG, only in a different place. The second dose is given at an age of 1-2 months, and the third dose six months after the first. If the child weighs <2 kg, the first dose of the vaccine may be less effective. Subsequent doses are given at the age of 30 days (or at discharge from the hospital days) and then two more cans of 1-2 months and 6 months after the 30-day dose. Infants whose mothers have an unknown HBsAg status at birth should also be vaccinated within 12 hours after birth. In children <2 kg, the first vaccine is administered simultaneously with the HBIG (0.5 ml i.m.), at a different location. can be assayed for HBsAg for infants whose mothers ? 2 kg, and in which a follow-up is guaranteed, can HBIG (0.5 ml i.m.) are delayed in anticipation of a positive test for HBsAg maternal up to 7 days. Tests for HBsAg and anti-HBs in an age of 9-15 months is recommended for all children of HBsAg-positive mothers. The separation of newborns from their HBeAg positive mothers is not recommended, even breast-feeding does not appear to increase the risk of postpartum transmission, especially if one HBIG and HBV vaccination has taken place. However, HBV infection can be transmitted through breast-feeding, if a violation of the nipple, an abscess or other disease of the breast is present in the mother. Summary HBV is the sole cause of neonatal hepatitis, it is usually transmitted during childbirth. The vast majority of newborns are asymptomatic, but developed a chronic, subclinical HBs antigenemia with increased transaminase. Some children develop a mild hepatitis, a few suffer from fulminant liver disease. Serological tests of infant and mother should be made. Infants whose mothers are HBsAg positive should, at a dose of 0.5 ml HBIG i.m. and HBV within 12 h are inoculated after birth. HBV-infected children should be immunized with hepatitis A vaccine; Drugs against HBV (eg., Interferon alfa) can help, but should only be used in consultation with a pediatric hepatologist.

Health Life Media Team

Leave a Reply