Text VI. Hepatitis

Neonatal hepatitis may have multiple infectious causes.

Hepatitis A (HAV). Transmission of HAV to the neonate is possible if the mother is in the incubation period or is acutely symptomatic at the time of delivery or by transfusion of infected blood. In the neonate, the virus is detectable in the stool for several weeks without obvious clinical illness. This poses a hazard to susceptible care takers. HAV infection is established by detecting antigen in the stool or by findings anti-HAV-IgM antibody in serum specimens.

Enteric precautions are recommended for duration of hospitalization. In the infant born to an acutely symptomatic mother, human immune serum globulin should be considered although its effectiveness is unknown. The occurrence of HAV infection earlier in pregnancy is not an indication for withholding breast feeding or administration of immune serum globulin.

Hepatitis B (HBV). Incidence varies with ethnic origin of mother, the timing and type of maternal infection, whether or not mother is HBsAg and “e” positive. Transplacental transmission is rare. Transmission to an infant by HBsAg-positive mother occurs during or shortly after delivery. HBIG and Heptavax are used to protect the infant from acute infection and development of chronic infection.

A mother with acute (symptomatic) hepatitis late in pregnancy or shortly after delivery is much more likely to transmit infection to her infant than a mother with acute infection early in pregnancy or the mother who is a chronic carrier. The infected infant of a chronic carrier is more likely to develop severe chronic liver disease. Chronic liver disease is more common in Asians.