Long-Term Follow-up of Neonatal Hepatitis: Safety and Value of Surgical Exploration

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Abstract
A retrospective analysis of 23 patients with neonatal hepatitis revealed two classes of cases: familial (5) and sporadic (18). All five patients with familial disease and nine of those with sporadic disease underwent diagnostic laparotomy and liver biopsy; in the remaining nine sporadic cases, operations were not done. The patients subjected to surgery had a worse outcome than those in the nonsurgical group. However, familial neonatal hepatitis had significantly more serious morbidity and mortality than the sporadic disease, whether or not surgically treated. Moreover, when the familial cases were excluded from the total surgical group, no statistically significant difference in outcome appeared at long-term follow-up between the operative and nonoperative sporadic groups. We suggest that familial obstructive neonatal jaundice caused the apparent poor prognosis in our total operative series. Exploratory laparotomy, without biliary duct exploration, need not alter the future course of infants with neonatal hepatitis who lack a positive family history. Therefore, early laparotomy may be safe and useful not only in establishing diagnosis, but also in salvaging a small number of infants with surgically correctable biliary atresia.

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