新生儿肝炎如何治疗（图）www.39.net 2007-06-28 加拿大肝脏基金会
NeonatalHepatitis
Whatisneonatalhepatitis?
Neonatalhepatitisisaninflammationoftheliverthatoccursinearlyinfancy,usuallyonetotwomonthsafterbirth.About20percentofinfantswhodevelopneonatalhepatitiswereinfectedwithaviruscausinginflammationofthelivereitherbeforebirththroughtheirmother,orshortlyafterbirth.Viruseswhichcancauseneonatalhepatitisininfantsincludecytomegalovirus,rubella（measles）,andhepatitisA,BandC.Intheremaining80percentofaffectedinfants,nospecificcausecanbeidentified,butmanyexpertssuspectavirusistoblame.
Whatarethesymptomsofneonatalhepatitis?
Aninfantwithneonatalhepatitisusuallyhasjaundice（yelloweyesandskin）thatappearsatonetotwomonthsofage.Jaundiceoccurswhentheflowofbilefromtheliverisblockedduetoaninflammationorobstructionofthebileducts.Sincebileisessentialinthedigestionoffatsandabsorptionoffatsolublevitamins,achildwithneonatalhepatitismayfailtogainweightandgrownormally.Theinfantwillalsohaveanenlargedliverandspleen.
Howisneonatalhepatitisdiagnosed?
Thediagnosisofneonatalhepatitisisinitiallybasedonbloodtestsaimedatidentifyingpossibleviralinfectionsleadingtothedisease.Incaseswherenovirusisidentified,aliverbiopsyisperformed.Thisinvolvestheremovalofasmallpieceoftheliverusingaspecialsyringeforexaminationunderamicroscope.
Biopsyresultswilloftenshowthatgroupsoffourorfivelivercellshavejoinedtogethertoformlargercells.Althoughtheselargecellscontinuetofunction,theydosoatalesserratethannormallivercells.Thistypeofneonatalhepatitisissometimescalledgiantcellhepatitis.
Thesymptomsofneonatalhepatitisaresimilartothoseassociatedwithanotherinfantliverdiseasecalledbiliaryatresia.Ininfantswithbiliaryatresiahowever,bileductsareprogressivelydestroyedforreasonsthatarepoorlyunderstood.Althoughaninfantwithbiliaryatresiaisalsojaundicedwithanenlargedliver,thereisgenerallynormalgrowthandthespleenisnotinflamed.Inadditiontosymptoms,aliverbiopsyandbloodtestsareneededtodistinguishbiliaryatresiafromneonatalhepatitis.
Whatcomplicationsareassociatedwithneonatalhepatitis?
Infantswithneonatalhepatitiscausedbyrubellaorcytomegalovirusareatriskofdevelopinganinfectionofthebrainthatcouldleadtomentalretardationorcerebralpalsy.Manyoftheseinfantswillalsohavepermanentliverdiseaseduetothedestructionoflivercellsandtheresultingscarring（cirrhosis）.
Themajorityofinfantswithgiantcellhepatitiswillrecoverwithlittleornoscarringtotheliver.Theirgrowthpatternwillalsonormalizeasbileflowimproves.However,about20percentofaffectedinfantswillgoontodevelopchronic（ongoing）liverdiseaseandcirrhosis.Inthesechildren,theliverbecomesveryhardduetoscarring,andthejaundicedoesnotdissipatebysixmonthsofage.Infantswhoreachthispointinthediseaseeventuallyrequirealivertransplant.
Infantswithchronicneonatalhepatitiswillnotbeabletodigestfatsandabsorbfatsolublevitamins（A,D,EandK）asaresultofinsufficientbileflowandthedamagecausedtolivercells.ThelackofvitaminDwillleadtopoorboneandcartilagedevelopment（rickets）.AdeficiencyinvitaminAmayaffectnormalgrowthandvision.VitaminKdeficiencyisassociatedwitheasybruisingandatendencytobleed,whereasthelackofvitaminEresultsinpoorcoordination.Sincebileisresponsiblefortheeliminationofmanytoxinsinthebody,chronicneonatalhepatitiscanalsoleadtoabuildupoftoxinsinthebloodwhichinturnmayresultinitching,skineruptionsandirritability.
Howisneonatalhepatitistreated?
Thereisnospecifictreatmentforneonatalhepatitis.Vitaminsupplementsareusuallyprescribedandmanyinfantsaregivenmedicationswhichimprovebileflow.Formulascontainingfatsmoreeasilydigestedbythebodyarealsogiven.
Canneonatalhepatitisbespreadtoothers?
Infantswithneonatalhepatitiscausedbythecytomegalovirus,rubellaorviralhepatitismaytransmittheinfectiontootherswhocomeinclosecontactwiththem.Theseinfectedinfantsshouldnotcomeintocontactwithpregnantwomenbecauseofthepossibilitythatthewomancouldtransmitthevirustoherunbornchild.
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