An unusual case of intrauterine symptomatic neonatal liver failure.
We present an unusual case of neonatal liver failure. Isolated ascites was diagnosed in a female fetus at week 34 gestational age upon routine ultrasound. In the 35th week of gestation a cesarean section was carried out after puncture of fetal ascites. After birth the patient showed symptoms and complications of acute liver failure with portal hypertension. High serum ferritin concentrations, MRI findings compatible with tissue iron overload and no evidence for infectious disease or inborn errors of metabolism suggested possible neonatal hemochromatosis (NH). HFE gene mutation analysis studies of the child and parents were negative. An anti-oxidative and iron chelating therapy was introduced, followed by clinical stabilisation of the newborn and normalisation of liver function. The liver biopsy at 4 month of age showed mild fibrosis with a few iron-loaded hepatocytes and macrophages. At 2 years of age the child was virtually healthy.


CONCLUSIONS
The clinical course of our patient indicates that the pathological changes in the liver being associated with presumptive NH may be reversible when NH is diagnosed early and antioxidative and chelating therapy is immediately initiated.
Keller
M
M
Department of Pediatrics IV, Neonatology, Neuropediatrics and Metabolic Diseases Medical University Innsbruck, Austria. matthias.keller@i-med.ac.at
Scholl-Buergi
S
S
Sergi
C
C
Theurl
I
I
Weiss
G
G
Unsinn
K M
KM
Trawöger
R
R
D000367:Age Factors; D000975:Antioxidants / Q000627:therapeutic use; D001201:Ascites / Q000000981:diagnostic imaging*; D001706:Biopsy; D002585:Cesarean Section; D005260:Female; D005293:Ferritins / Q000097:blood; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D005865:Gestational Age; D006432:Hemochromatosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000175:diagnosis; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D017114:Liver Failure, Acute / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D013997:Time Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000975:Antioxidants; D007502:Iron Chelating Agents; D005293:Ferritins