Editorial team (being constituted) includes: Dr. Rani Bashir
Last edited: April 11, 2021
Applying an Age-Specific Definition to Better Characterize Etiologies and Outcomes in Neonatal Acute Liver Failure. Neonatal acute liver failure (ALF) is a rare disease with high mortality. The authors performed a single-center 11-year retrospective study 43 neonates who were ≤30 days’ old and had ALF as defined by an INR of ≥ 2. Etiologies included viral infection (23%), gestational alloimmune liver disease with neonatal hemochromatosis (GALD-NH) (21%), cardiac-associated ischemia (16%), other ischemia (14%), genetic etiologies (9%), Trisomy 21-associated myelodysplasia (7%), hemophagocytic lymphohistiocytosis (HLH) (2%), and not identified (7%). Infants with viral etiologies had the highest alanine aminotransferase at presentation (1179 IU/L, IQR 683-1585 IU/L) in contrast to low levels in GALD-NH (23 IU/L, IQR 18-64 IU/L). Across all etiologies only 33% were alive at 1 year. Overall median survival was 74 days; 17 days for viral infection and 74 days for GALD-NH. Among laboratory values at presentation, alpha-fetoprotein was significantly higher in patients that survived with their native liver (p = 0.04). Overall, the outcome for neonatal ALF is poor. Further studies are needed to identify laboratory parameters that predict survival with native liver by etiology to improve outcomes.
Recent developments in etiology and disease modeling of biliary atresia: a narrative review. Biliary atresia (BA) is a rare fibro-inflammatory disease of the extra- and intrahepatic bile ducts. It is the most common indicator for pediatric liver transplantation and is often fatal. Currently, the mainstay of treatment involves surgically correcting the extrahepatic biliary obstruction via Kasai hepato-portoenterostomy. The pathophysiology of liver inflammation and cirrhosis is unclear. There is some information that a potential viral infection in the early peri- or postnatal period may be the trigger of biliary epithelial injury and associated ductal disease, but further work is needed.
Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors. Incisional hernia (IH) is often seen in infants after abdominal surgery. The authors studied 2055 infants (1998-2018) aimed to identify the incidence, high-risk diseases, and other clinical risk factors of IH following abdominal surgery. The overall incidence of IH was 5.2% (107/2055). Necrotizing enterocolitis (12%), gastroschisis (19%), and omphalocele (17%) were the most common underlying diseases. Wound infection (OR: 5.3, 95%-CI:2.9-9.5), preterm birth (OR: 4.2, 95%-CI:2.6-6.7) and history of stoma (OR 1.7, 95%-CI:1.1-2.8) were significant risk factors. Age at surgery, surgical approach, and total number of operations did not influence IH development. IH resolved in 15% (16/107) without surgery.
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