All you need to know about Paediatric Liver Diseases

The liver is the largest organ in the human body located under the lower rib cage on the right side of the abdomen. It is a vital organ that performs various essential functions related to metabolism, energy storage and detoxification of waste. In other words, it helps maintain a healthy level of blood sugar, cleans the blood by getting rid of toxins from the bloodstream and regulates the digestive system. Therefore, it becomes extremely important to take good care of the liver in order to maintain our overall health.

Children may suffer from numerous various liver conditions and problems. These are called paediatric liver diseases. Let’s look at some of the most common liver conditions in children including their symptoms, diagnosis and treatment.

Newborn Jaundice

Jaundice is a yellow discolouration of the skin and whites of the eyes due to an elevated level of the yellowish pigment in the blood called bilirubin. Infant jaundice occurs when a baby has a high level of bilirubin in the blood, causing yellowing of the skin and whites of the eyes. It is also called physiological jaundice and neonatal jaundice. Jaundice is a common condition in newborn babies as their livers are still developing and are not mature or capable enough to remove bilirubin like in older children or adults. Also, babies who are born prematurely or too early are more likely to develop jaundice than full-term babies. The symptoms of newborn jaundice are noticeable when the baby is 2-4 days old. It is usually harmless and disappears on its own within 2-3 weeks as the baby’s liver matures without any treatment. However, if jaundice sticks around longer than 3 weeks, it can be a sign of an underlying health condition. It is crucial to monitor the bilirubin level of the baby and ensure it does not get too high as the bilirubin could pass into the brain and cause brain damage. Prompt treatment may prevent significant lasting damage.

Talk to your baby’s doctor if you notice these symptoms:

• Pale-coloured stools

If your baby’s poop is white or chalky grey and pale yellow in colour, it can be a sign of liver problems. It needs prompt treatment.

• The dark and yellow colour of the baby’s urine

If your baby’s urine is dark and yellow in colour due to the presence of bile in the urine, it indicates liver disease as newborn babies’ urine should be colourless. Seek immediate medical attention.

Test for prolonged jaundice

If your baby has prolonged jaundice, a blood test called a split bilirubin blood test is necessary.

• The split bilirubin test measures the levels of direct or conjugated bilirubin and unconjugated or indirect bilirubin in the baby’s blood.
• This test will also help to check whether the baby’s jaundice is caused by an underlying condition such as liver disease.
• If your baby’s conjugated bilirubin level is more than 20% of the total bilirubin, this suggests that they have a liver disease which needs further investigation.
• Seek immediate treatment in case of the baby’s high levels of unconjugated bilirubin as it could cause brain damage.

Paediatric Cirrhosis

Cirrhosis is a progressive liver disease that occurs when healthy liver cells are damaged and scarred. As scar tissue interferes with the functions of the liver leading to blockage, the blood circulation and build-up of the waste products in the body. Cirrhosis in paediatric patients is caused by scarred tissues obstructing the proper functioning of the liver. Cirrhosis in children is most often caused by genetic or inherited liver problems and other liver conditions such as autoimmune hepatitis, hepatitis B and/or C. The severity of cirrhosis depends on the extent of liver damage and in extreme cases, the liver might stop working requiring a liver transplant.

Cirrhosis Diagnosis

If there is a suspicion that the child has cirrhosis, the doctor will run several tests to confirm the diagnosis. These tests include:

• Blood Tests

A small amount of blood may be taken and tested to check how well the liver is working and to determine the cause.

• Computed Tomography (CT) Scan, Ultrasound, MRI Scan

These tests identify changes in the liver and gallbladder as well as check the functioning of the child’s liver. The presence of gallstones, abscesses, abnormal blood vessels and abnormal bile ducts is detected.

• Liver Biopsy

This is a procedure that determines how badly liver tissue is damaged. A thin needle is used to remove a sample of tissues from the liver which is analysed in the laboratory for signs of inflammation, scarring or other problems.

Cirrhosis Treatment

Normally, there is no way to cure cirrhosis and the condition cannot be reversed. However, it is a chronic condition that can lead to serious complications if left untreated. Children with cirrhosis are required to receive ongoing medical treatment and care throughout their lives. The purpose of treatment is to prevent the liver from further damage, treat symptoms and complications and address the underlying medical condition. Treatment for children with cirrhosis may vary but a healthy diet and regular monitoring of the condition are crucial to prevent further damage.

• Medication

Your child’s paediatrician may prescribe drugs to treat, control and prevent symptoms, and complications and fight infections of the underlying liver disease. Some types of acute liver failure can be treated with medicines such as those caused by heart problems or toxins. However, it is critical to talk to a child specialist before giving the child any new medications or supplements as a damaged liver cannot break down medicines as quickly as a healthy liver.

• Regular monitoring & taking precautions

Cirrhosis can lead to complications in many organs and systems in the body. However, taking precautions and regular monitoring can help treat and prevent further complications. Ensure that your child gets influenza and hepatitis vaccines as recommended by the doctor.

• Healthy diet

Eating healthy is crucial for children with cirrhosis to prevent or slow further damage to the liver. The liver’s important function is to help the stomach absorb nutrients. The child’s paediatrician may also prescribe supplements or special formulas to promote healthy weight gain and development of the child. Make sure that you follow all instructions regarding the diet and that your child takes supplements as prescribed.

• Liver transplant

Children with cirrhosis are at risk of serious complications such as liver failure and liver cancer. When the complications of cirrhosis can no longer be controlled and the liver is failing to function properly, a liver transplant is the best option for the child.

Meet the best neonatologists & paediatricians at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad

Dr. Ashish Prakash is an experienced and eminent paediatrician of Ghaziabad with more than 30 years in neonatology & paediatrics. Presently, he is the Head of the Department of Neonatology & Paediatrics at Yashoda Hospital & Research Centre, Ghaziabad. An alumnus of the prestigious AIIMS, New Delhi, he did a further 3-year super-speciality training in neonatology at The Children’s Hospital at Westmead, Sydney.

Dr. Arun Kumar has worked in the field of advanced paediatric medicine for over 20 years. Prior to Yashoda, he was associated with Safdarjung Hospital and Dr. Ram Manohar Lohia Hospital located in New Delhi.

Dr. (Maj.) Sachin K. Dubey is a responsible, energetic and experienced senior consultant in the Department of Neonatology at Yashoda Hospital & Research Centre. He has been practising neonatology for the last 10 years and has indelible experience in neonatal intensive care & growth and developmental assessment.

Dr. Karan Raheja is trained in haemodynamic monitoring and bedside USG monitoring along with echocardiography. He has a fellowship in paediatric intensive care from Sir Ganga Ram Hospital, New Delhi.