Viral hepatitis B in neonates and infants

• Published in: The American journal of medicine Vol. 55; no. 6; pp. 762 - 771
• Main Authors: Schweitzer, Irvin L., Dünn, Alfred E.G., Peters, Robert L., Spears, Robert L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.1973
• Subjects: Alanine Transaminase - blood; Biopsy, Needle; Birth Weight; Blood; Child, Preschool; Chronic Disease; Female; Gestational Age; Hepatitis A; Hepatitis B Antigens - isolation & purification; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Liver - pathology; Maternal-Fetal Exchange; Microscopy, Electron; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Umbilical Cord
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/0002-9343(73)90257-X

The hepatitis B antigen (HBAg) was detected in 17 of 31 infants whose mothers had acute hepatitis B while pregnant or in the first 2 postpartum months. Neonatal infection developed in 1 of 10 babies when maternal hepatitis occurred in the first two trimesters and in 16 of 21 when it occurred in the third trimester or within 2 months after delivery. The cord bloods of seven infants who become antigen-positive were tested and HBAg was detected in four. In 2 of the 17 infected infants acute icteric hepatitis developed at 3 and 4 months of age. In these cases, the illness was mild, HB antigenemia was transient, and significant titers of hepatitis B antibody (HBAb) developed following recovery. Thirteen infants who became infected showed no clinical signs of illness, but their serums remained consistently antigen-positive for up to 39 months with prolonged serum glutamic pyruvic transaminase (SGPT) elevations. Liver biopsies performed on 10 infants between 3 and 27 months of age revealed the histologic features of unresolved hepatitis. In addition, increased portal fibrosis was observed in one case. Electron microscopic examination revealed 24 nanometer virus-like particles in hepatocyte nuclei of six of nine cases studied. The most consistent pathologic change seen at the ultrastructural level was cytoplasmic “ballooning” which occurred in some areas of every case. The most common response of neonates to hepatitis type B virus (HBV) exposure is chronic, hepatitis B with the histologic features of unresolved hepatitis. Long-term follow-up will be required to determine the final evolution of this lesion. An occasional neonate in whom acute icteric hepatitis B develops may experience rapid healing with prompt loss of antigenemia followed by the development of significant HBAb titers.