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Lin ES, Afridi F, Mysore SS, Presenza T, Kushnir A, Ahmed R. The Effect of Prolonged Antenatal Intravenous Immunoglobulin Treatment in Preventing Gestational Alloimmune Liver Disease-A Case Series with Literature Review. AJP Rep 2025; 15:e1-e5. [PMID: 39780941 PMCID: PMC11706633 DOI: 10.1055/a-2496-8690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/10/2024] [Indexed: 01/11/2025] Open
Abstract
Background Gestational alloimmune liver disease (GALD) is characterized by maternal IgG-directed fetal hepatocyte damage and can lead to severe liver failure and fetal or infant death. Moreover, GALD is associated with a near 90% risk of recurrence in subsequent pregnancies. Case We present a case of a newborn patient delivered to a 32-year-old G2P1000 mother who received prolonged antenatal intravenous immunoglobulin (IVIG) treatment during the current pregnancy due to the neonatal death of the first child from GALD-related liver failure. Postnatal testing, including a liver magnetic resonance imaging (MRI) and buccal biopsy of this newborn, showed normal morphology of the liver without any abnormal iron deposition. Additional laboratory testing showed a lack of any liver injury. Conclusion This case supports the use of antenatal IVIG immunotherapy to prevent the recurrence of GALD in subsequent pregnancies. Key Points GALD can lead to severe fetal liver injury.GALD is highly recurrent in subsequent pregnancies.Prophylactic IVIG may prevent GALD recurrence.
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Affiliation(s)
- Eena Sunya Lin
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Faraz Afridi
- Department of Pediatric Hematology-Oncology, MD Anderson Children's Cancer Hospital, Houston, Texas
| | - Sukrita Sheshu Mysore
- Department of Pediatric Gastroenterology, University of Maryland, Baltimore, Maryland
| | - Thomas Presenza
- Department of Diagnostic Imaging, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Alla Kushnir
- Department of Neonatal-Perinatal Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Rafat Ahmed
- Department of Pediatric Hematology-Oncology, Cooper Medical School of Rowan University, Camden, New Jersey
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2
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Xu S, Zhang P, Ge M, Shan Y, Cheng G. Clinical characteristics and outcomes of acute liver failure in neonates: a retrospective cohort in China. Eur J Pediatr 2024; 183:3211-3218. [PMID: 38689183 PMCID: PMC11263379 DOI: 10.1007/s00431-024-05567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
Neonatal acute liver failure (NALF), as a rare disease with high mortality, has limited relevant literature reports in China. We attempted to analyze a NALF cohort to improve the prognosis of this disease. We included all patients diagnosed with NALF at our institution between 2016 and 2021 and retrospectively reviewed their electronic records. NALF was defined as an INR ≥ 2.0 due to liver disease 28 days after birth. Comparisons were made according to etiology and outcome. The Kaplan-Meier method was used to estimate survival. Fifty-eight patients were included in this study. Etiologies included hypoxic/ischemic injury (29.3%), infection (27.6%), gestational alloimmune liver disease with neonatal hemochromatosis (GALD-NH) (10.3%), inherited metabolic diseases (5.2%), hemophagocytic lymphohistiocytosis (1.7%), other etiologies (12.1%), and unidentified causes (13.8%). Enteroviruses constituted 87.5% of the viral infections, whereas herpes simplex virus accounted for no infections. The median INR was significantly lower in the infection group than in the GALD-NH group (P < 0.05 for multiple comparisons). At the last follow-up, none of the patients had undergone liver transplantation, and the overall mortality rate was 50%. Liver function completely recovered in 31% of the patients, all of whom survived. The overall median survival time was 48 days; 26 days for hypoxic/ischemic injury and 43 days for GALD-NH. The incidence of cholestasis was significantly greater among surviving patients (P = 0.018). Conclusion: Hypoxic/ischemic injury and infection are the predominant etiologies of NALF in China. The overall prognosis of NALF is poor, but its short-term prognosis is determined by the etiology. What is Known: • Neonatal acute liver failure (NALF) is a rare disorder with limited cohort studies, especially in China. • Gestational alloimmune liver disease, viral infections (especially herpes simplex virus), metabolic diseases and ischemic insults are common etiologies of NALF, which are significantly different from other populations. • There are no reliable biochemical markers to predict the outcome of NALF. What is New: • In this first report on a Chinese NALF cohort, we demonstrate that hypoxic/ischemic injury and infection (excluding herpes simplex virus) are the predominant etiologies of NALF. • The overall prognosis of NALF is poor, and its etiology determines the short-term outcome.
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Affiliation(s)
- Suhua Xu
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Peng Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Mengmeng Ge
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yuanyuan Shan
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guoqiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital, Xiamen, China.
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3
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Zermano S, Novak A, Vogrig E, Parisi N, Driul L. GALD: new diagnostic tip for early diagnosis - a case report and literature review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1077304. [PMID: 37251532 PMCID: PMC10213929 DOI: 10.3389/frph.2023.1077304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Gestational alloimmune liver disease is a rare and serious condition caused by a maternal-fetal alloimmune disorder. There are not many studies about the antenatal treatment (IVIG infusion) of affected fetuses as the diagnosis is generally made postnatally. The possibility of an early diagnosis by means of ultrasonography and a gynecologist's assesment can provide prompt treatment of this disease. Case report We report the case of 38-year-old pregnant woman referred to our centre in view of severe fetal hydrops seen by ultrasound at 31 weeks + 1 day gestation. A male infant was born and subsequently died after developing liver failure. Postmortem examination revealed the presence of diffuse hepatic fibrosis in the absence of hemosiderin deposits and no extrahepatic siderosis. Immunohistochemical analysis was also performed which showed diffuse hepatocyte positivity for the terminal complement complex (C5b-C9) confirming the suspicion of GALD. Methods A comprehensive literature search published from 2000 to 2022 was conducted on PubMed and Scopus. Paper selection was performed following the PRISMA guidelines. Fifteen retrospective studies were identified and selected. Results A total of 15 manuscripts describing 26 cases were finally included in our research. Twenty-two fetuses/newborns with suspected GALD were studied, of which 11 had a confirmed histopathological diagnosis of GALD. Prenatal diagnosis of gestational alloimmune liver disease is difficult because ultrasound findings may be absent or nonspecific. Only one case report described fetal hydrops similar to our clinical case. As highlighted by the current case, in fetuses presenting with hydrops, once the most common etiologies have been excluded, hepatobiliary complications and liver failure caused by GALD should be considered. Conclusions Global knowledge of this disorder and its wide spectrum of presentations may help to increase the number of cases that are diagnosed early and accurately. The recurrence rate of an infant being affected with GALD in another pregnancy is more that 90%. Recurrence however can be prevented by treatment with IVIG during pregnancy. This highlights the importance of having obstetricians and pediatricians familiar with gestational alloimmune liver disease.
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Affiliation(s)
- Silvia Zermano
- Department of Medicine, University of Udine, Udine, Italy
| | - Alice Novak
- Department of Medicine, University of Udine, Udine, Italy
| | - Emanuela Vogrig
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Nadia Parisi
- Department of Medicine, University of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy
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4
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Şenel SA, Bilirer KK, Acar S, Erenel H. Liver Cirrhosis Due to Fetal CMV Infection: A Case Report. Fetal Pediatr Pathol 2023; 42:315-319. [PMID: 36062953 DOI: 10.1080/15513815.2022.2116617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: CMV is the most common cause of congenital viral infection. We observed a cirrhotic liver and intracerebral hemorrhage due to fetal CMV infection. Case presentation: Fetal CMV infection was diagnosed at 20 weeks of gestation, leading to termination of pregnancy. At fetopsy, the liver was macronodularly cirrhotic with necrosis and CMV inclusions. Intracerebral hemorrhage, seen on the prenatal ultrasound, was confirmed. Discussion/Conclusion: Congenital CMV infection can cause cirrhosis and intracerebral hemorrhage as early as 20 weeks gestation.
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Affiliation(s)
- Selvi Aydın Şenel
- Perinatology Department, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Kübra Kurt Bilirer
- Perinatology Department, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Selma Acar
- Pathology Department, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Hakan Erenel
- Perinatology Department, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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5
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Cave JJ, Chaudhary A, Tsigka A, Tan YW. Vanishing enteric duplication cyst presenting with melaena. BMJ Case Rep 2022; 15:e250012. [PMID: 36028242 PMCID: PMC9422808 DOI: 10.1136/bcr-2022-250012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/04/2022] Open
Abstract
A toddler presented with melaena on a background of a possible enteric duplication cyst, diagnosed in the neonatal period which 'vanished'. What was later confirmed to be a small bowel duplication cyst was not seen on follow-up ultrasounds and thus the patient was managed expectantly until presentation as an emergency. Our case highlights the challenges faced in managing cystic abdominal structures in infancy and the potential consequences of expectant management. We discuss whether cross-sectional imaging or diagnostic laparoscopy should be advocated when duplications cysts are considered amongst the differentials of a lesion on ultrasound.
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Affiliation(s)
- Joshua J Cave
- Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Ahsan Chaudhary
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alexia Tsigka
- Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Yew-Wei Tan
- Department of Paediatric Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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6
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Kelchtermans J, Pinney SE, Leonard JMM, Mcgrath-Morrow S. Diagnostic and management considerations in pseudohypoaldosteronism type 1b. BMJ Case Rep 2022; 15:e246538. [PMID: 34980640 PMCID: PMC8724702 DOI: 10.1136/bcr-2021-246538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
Pseudohypoaldosteronism type 1B is a rare autosomal recessive disorder caused by dysfunction of amiloride-sensitive epithelial sodium channels (ENaCs). We present the case of a neonate with cardiogenic shock after cardiac arrest due to profound hyperkalaemia. Genetic testing revealed a novel homozygous variant in SCNNIA We review diagnostic considerations including the molecular mechanisms of disease, discuss treatment approaches and highlight the possible significance of the diversity of pulmonary ENaCs.
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Affiliation(s)
- Jelte Kelchtermans
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sara E Pinney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jacqueline M M Leonard
- Roberts Individualized Medical Genetics Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sharon Mcgrath-Morrow
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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7
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Zanella G, Andrade S, Cont G, Pavan M, Nider S, Barbi E, Risso FM. Two newborns with crooked mouths. Arch Dis Child Educ Pract Ed 2021; 106:100-102. [PMID: 31270143 DOI: 10.1136/archdischild-2018-316754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/18/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Giada Zanella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefanny Andrade
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Gabriele Cont
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Matteo Pavan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Silvia Nider
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
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8
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AlGhoozi DA, AlKhayyat HM. A child with Henoch-Schonlein purpura secondary to a COVID-19 infection. BMJ Case Rep 2021; 14:e239910. [PMID: 33408113 PMCID: PMC10577763 DOI: 10.1136/bcr-2020-239910] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/04/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) is a common IgA-mediated small vessel vasculitis of childhood that affects several systems. It is characterised by a tetrad of dermatological, abdominal, joint and renal manifestations. HSP can occur secondary to upper respiratory tract infections, medications, vaccinations and malignancies. COVID-19 is caused by SARS-CoV-2, a single-stranded RNA virus from the Beta-Coronaviridae family, and often presents as a respiratory infection with symptoms ranging from a mild common cold-like illness to severe pneumonia. It has also been reported to exhibit extrapulmonary manifestations, including but not limited to cardiac, thrombotic, hepatocellular and dermatological complications. We report a case of a 4-year-old boy who presented with clinical features of HSP, with detailed history that revealed a recent recovery from a COVID-19 upper respiratory tract infection, indicating a possible correlation between the two.
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9
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Alsaleem M. Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review. Antibodies (Basel) 2020; 9:E60. [PMID: 33158209 PMCID: PMC7709108 DOI: 10.3390/antib9040060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.
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Affiliation(s)
- Mahdi Alsaleem
- Pediatrics Department, Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Pediatrics Department, University of Kansas, Wichita, KS 67208, USA
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10
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Concejo Iglesias P, Liébana de Rojas C, Bartolomé Mateos A, Risco Montemayor B, Rasero Ponferrada M, Galindo A. Usefulness of dual gradient-echo MR imaging for the prenatal diagnosis of gestational alloimmune disease. J OBSTET GYNAECOL 2020; 41:981-983. [PMID: 33078635 DOI: 10.1080/01443615.2020.1798907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Alba Bartolomé Mateos
- Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Alberto Galindo
- Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Madrid, Spain
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11
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Dempsey E, Homfray T, Simpson JM, Jeffery S, Mansour S, Ostergaard P. Fetal hydrops – a review and a clinical approach to identifying the cause. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1719827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Esther Dempsey
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Tessa Homfray
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steve Jeffery
- Molecular and Clinical Sciences, St George’s University of London, London, UK
| | - Sahar Mansour
- Molecular and Clinical Sciences, St George’s University of London, London, UK
- SW Thames Regional Genetics Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pia Ostergaard
- Molecular and Clinical Sciences, St George’s University of London, London, UK
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12
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Taylor H, Laurence ADJ, Uhlig HH. The Role of PTEN in Innate and Adaptive Immunity. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a036996. [PMID: 31501268 DOI: 10.1101/cshperspect.a036996] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The lipid and protein phosphatase and tensin homolog (PTEN) controls the differentiation and activation of multiple immune cells. PTEN acts downstream from T- and B-cell receptors, costimulatory molecules, cytokine receptors, integrins, and also growth factor receptors. Loss of PTEN activity in human and mice is associated with cellular and humoral immune dysfunction, lymphoid hyperplasia, and autoimmunity. Although most patients with PTEN hamartoma tumor syndrome (PHTS) have no immunological symptoms, a subclinical immune dysfunction is present in many, and clinical immunodeficiency in few. Comparison of the immune phenotype caused by PTEN haploinsufficiency in PHTS, phosphoinositide 3-kinase (PI3K) gain-of-function in activated PI3K syndrome, and mice with conditional biallelic Pten deletion suggests a threshold model in which coordinated activity of several phosphatases control the PI3K signaling in a cell-type-specific manner. Emerging evidence highlights the role of PTEN in polygenic autoimmune disorders, infection, and the immunological response to cancer. Targeting the PI3K axis is an emerging therapeutic avenue.
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Affiliation(s)
- Henry Taylor
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, United Kingdom
| | - Arian D J Laurence
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Nuffield Department of Experimental Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.,Department of Haematology, University College London Hospitals NHS Trust, London WC1E 6AG, United Kingdom
| | - Holm H Uhlig
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Nuffield Department of Experimental Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.,Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.,NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, United Kingdom
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13
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Sidana V, Rajasekaran R, Kumar J, Mukhopadhyay K. Spontaneous resolution of pneumopericardium in a preterm infant. BMJ Case Rep 2019; 12:e230339. [PMID: 31068357 PMCID: PMC6506135 DOI: 10.1136/bcr-2019-230339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vishal Sidana
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jogender Kumar
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanya Mukhopadhyay
- Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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14
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Kasko O, Klose E, Rama G, Newberry D, Jnah A. Gestational Alloimmune Liver Disease: A Case Study. Neonatal Netw 2019; 37:271-280. [PMID: 30567809 DOI: 10.1891/0730-0832.37.5.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gestational alloimmune liver disease (GALD) is initiated by maternal antibodies that attack fetal hepatocytes. The fetal immune response to the antibodies causes liver damage. The incidence of GALD is four per 100,000 live births in the United States. Frequently, liver injury leads to fetal loss or neonatal demise; nonetheless, the presentation of GALD has a wide range of severity. Survival rates have increased from 20 to 80 percent changes in treatment and understanding of GALD. Current treatment is focused on supportive care with intravenous immunoglobulin (IVIG) and exchange transfusions. Mortality risk is positively associated with the timing of diagnosis. Although there has been an increase in understanding this disease, the discovery of the specific alloantigen is still needed. Relevant embryology, pathophysiology, clinical manifestations, diagnosis, medical treatment, and prognosis are discussed to aid health care professionals in the early identification and treatment for the neonate and family unit.
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