Hepatitis and Liver Failure in Infancy and Childhood

Hepatitis in intrauterine and early postnatal life usually has different causes and clinical features than hepatitic processes experienced by older children and adults. The histologic features of neonatal hepatitis and hepatitis in early childhood are often significantly different than those observed in older patients. Because these features are by themselves frequently not diagnostic of any one liver disease, the pathologist must be familiar with all the potential causes and be able to suggest additional testing modalities, such as assays of metabolic enzymes, determination of specific metabolite levels, ultrastructural examination, or genomic testing, that may allow for a definitive diagnosis. In older children, the differential diagnosis of hepatitis overlaps to a greater extent with causes of hepatitis in adult patients, and a detailed discussion of those conditions is beyond the scope of this chapter.