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Hepatitis viruses and the newborn: Clinical manifestations and treatment

Author
Donough J O'Donovan, MD
Section Editors
Leonard E Weisman, MD
Sheldon L Kaplan, MD
Elizabeth B Rand, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Neonatal infections with the hepatitis viruses are typically the result of vertical transmission from infected mothers. The risk of perinatally- or neonatal-acquired infection, and its clinical manifestations and implications vary depending on the hepatotropic virus, and are reviewed here.

HEPATITIS A

Hepatitis A virus (HAV) is a nonenveloped 27-nm RNA virus that is a member of the Picornaviridae family. The virus is transmitted by person-to-person contact through fecal-oral contamination. The infection is highly contagious, and epidemics frequently result from common exposure to contaminated food and water. (See "Overview of hepatitis A virus infection in children" and "Hepatitis A virus infection in adults: An overview".)

Transmission

Maternal vertical transmission

Intrauterine — For the most part, HAV infection is self-limiting in pregnant women. Although maternal HAV infection does not appear to increase the risk of congenital malformations, stillbirths, intrauterine growth restriction, or spontaneous abortions [1,2], there is an increased risk of preterm labor and premature rupture of membranes. (See "Intercurrent hepatobiliary disease during pregnancy", section on 'Hepatitis A'.)

Although rare, two cases of intrauterine transmission of HAV in early pregnancy were reported [3,4]. These cases presented with fetal ascites and meconium peritonitis. After delivery, serologic testing confirmed HAV infection in both infants who required surgical intervention for meconium peritonitis. Their subsequent recovery was uneventful.

Perinatal — There are several case reports of vertical transmission of HAV weeks before or at delivery [5-7]. For most of these infants, vertical transmission was identified when the infant presented with hepatitis after the newborn period. Despite these reports, it appears that the risk of perinatal transmission is low given the widespread global distribution of HAV infection.

                             

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 31 00:00:00 GMT+00:00 2016.
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