What are the other Names for this Condition? (Also known as/Synonyms)

• Idiopathic Neonatal Hepatitis Syndrome
• INH (Idiopathic Neonatal Hepatitis)
• Neonatal Giant Cell Hepatitis

What is Idiopathic Neonatal Hepatitis? (Definition/Background Information)

• Idiopathic Neonatal Hepatitis (INH) is a liver disorder in newborn children that causes the liver to become inflamed, severely affecting its function
• The symptoms include yellowing of the skin and eyes, dark-colored urine, and itchy skin
• The cause of INH is not well understood. Currently, there is no clear explanation as to why this condition arises, shortly after birth. But despite these, most cases can be treated to full recovery, without long-term damages

Who gets Idiopathic Neonatal Hepatitis? (Age and Sex Distribution)

• The onset of Idiopathic Neonatal Hepatitis is normally within the first 3 months of birth. Male babies are affected slightly more than female babies
• The general incidence of INH is unknown, but the recorded numbers are decreasing. With advancing medical technologies, INH diagnosis is being made much earlier by healthcare providers, due to an increasing awareness of the condition
• No ethnic or racial preference is noted

What are the Risk Factors for Idiopathic Neonatal Hepatitis? (Predisposing Factors)

• Idiopathic Neonatal Hepatitis runs in the families. Hence, it is thought that children (including siblings) born in families with a medical history of the condition, may be at risk
• Newborn infants suffering from cholestasis (a condition in which there is obstruction of bile, flowing into the small intestine, from the liver), have a 30-40% chance of being affected by the disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Idiopathic Neonatal Hepatitis? (Etiology)

• The exact cause of Idiopathic Neonatal Hepatitis is unknown
• They are thought to occur spontaneously and there are may be many possible causes, such as:
  • Morphological anomalies in liver, bile duct abnormalities
  • Metabolic issues
  • Unidentified pathogenic agents, or
  • Genetic factors

What are the Signs and Symptoms of Idiopathic Neonatal Hepatitis?

Signs and symptoms of Idiopathic Neonatal Hepatitis are noticeable after the first few weeks. However, in some infants, INH is asymptomatic. The common indications include:

• Gradual yellowing of eyes and skin (face) initially, which then slowly spreads to the entire body
• Enlarged liver and spleen; the blood vessels appear swollen around these region
• Dark-colored urine, light grey stools
• Vomiting
• Some weight loss is observed; the baby-growth does not match a normal growth rate
• Baby may suffer severely itchy skin, causing irritability
• Accumulation of abdominal fluid

How is Idiopathic Neonatal Hepatitis Diagnosed?

A diagnosis of Idiopathic Neonatal Hepatitis is commonly made by considering all possible causes of jaundice in newborn; since, there are several types of baby jaundice.

Diagnostic tests for detecting INH, performed on the newborn child include:

• Physical exam with evaluation of medical history; evaluation of both the child and mother
• Blood analysis: Total blood count, peripheral blood smear test, blood typing, evaluation of serum bilirubin amount, count of old RBCs (reticulocytes), check for certain protein levels, platelet count
• Urine test and culture
• Ultrasound scan of abdomen
• Liver biopsy, using needle core biopsy
• Differential diagnosis should be considered to eliminate other jaundice types, liver diseases

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Idiopathic Neonatal Hepatitis?

Complications may develop with an increased frequency, if the infant is born preterm, or is severely malnourished, does not get the correct treatment, or if the treatment is delayed. Sometimes, the infant may also be affected by a severe form of Idiopathic Neonatal Hepatitis, where the condition progressively worsens.

The following complications may be observed:

• Liver failure, chronic liver disease
• Vision problems due to damage to the eyes
• Serious brain damage causing neurological abnormalities due to severe state of jaundice. This is  known as kernicterus
• Sepsis (blood infection)
• Skin gets affected such that bruising might occur easily. There could also be a bleeding tendency. Both of these occur due to a lack of vitamin K

How is Idiopathic Neonatal Hepatitis Treated?

Even though Idiopathic Neonatal Hepatitis manifests in the period following birth, aggressive treatment measures are often not really required in managing the condition. The treatment provided is basically meant to address the symptoms and any complications that develop. Some of the steps include:

• Diet and nutrition of the infant is very important and it has to be carefully planned and controlled. This might consists of specially-prepared formulas, vitamin supplementation, etc.
• Medications may be administered to stimulate the liver and aid in bile flow
• If the liver is severely damaged, then liver transplants may be required (though this is performed very infrequently)

How can Idiopathic Neonatal Hepatitis be Prevented?

Idiopathic Neonatal Hepatitis is a disorder of unknown origin that manifests itself shortly after birth. It cannot be prevented.

What is the Prognosis of Idiopathic Neonatal Hepatitis? (Outcomes/Resolutions)

• In a majority of the cases (about 80%), Idiopathic Neonatal Hepatitis resolves with adequate symptomatic treatment. There is a full recovery from the disorder
• Incorrect diagnosis, delayed treatment, malnourished condition of the child, could cause complications and result in serious liver damage, or chronic liver disease. In such cases, the prognosis is guarded

Additional and Relevant Useful Information for Idiopathic Neonatal Hepatitis:

• Neonatal hepatitis is caused due to a variety of reasons. They include viral infections, metabolic disorders, genetic factors/defects, and others
• Idiopathic means ‘arising from an unknown cause’