Hepatitis in children

Erythromycin estolate is usually not recommended for adults because of the increased risk of cholestatic hepatitis. In children, however, this derivative rarely causes hepatitis, and some pediatric specialists prefer this formulation because of better availabihty. 

Mieli-Vergani, G., Vergani, D. Autoimmune hepatitis in children. Clin. 

Halothane hepatitis in children is rare, and occurs in 1 82 000 to 1 200 000 exposures. Children as young as 11 months are not exempt from the risk, contrary to what was once thought and there is a growing number of reports of halothane hepatitis in children (47). It has been noted that sevoflurane is not metabolized to trifluor-oacetic acid and may prove to be a better alternative for repeated anesthesia in children (48). 

Halothane was first introduced into use as an anesthetic in 1956, and within 2 years, isolated case reports of liver complications and severe hepatitis were reported (Brody and Sweet 1963 Lindenbaum and Leifer 1963). A 1969 epidemiological study by the National Institutes of Health revealed an incidence of fatal hepatic necrosis of about 1 in 35,000 exposures. While concern for hepatotoxicity has virtually eliminated the use of halothane in adults in the US, halothane continues to be used as an anesthetic in children in the US because the incidence of halothane-associated hepatitis in children is between 1 in 82,000 and 1 in 200,000 (Carney and Van Dyke 1972 Kenna et al. 1987 Warner et al. 1984). Over the years, a variety of evidence has accumulated to spawn a range of theories and laboratory models. However, the exact mechanism leading to halothane... 

Increased morbidity following acute viral hepatitis in children with glucose-6-phosphate dehydrogenase deficiency. 

Druyts E, Thorlund K, Wu P, Kanters S, Yaya S, Cooper CL, et al. Efficacy and safety of pegylated interferon alfa-2a or alfa-2b plus ribavirin for the treatment of chronic hepatitis in children and adolescents a systematic review and meta-analysis. CUn Infect Dis... 

Liver function. As supportive treatment for infectious hepatitis in children, pangamic acid given orally for 10 to 20 days leads to a more marked and rapid decline in fever, liver size, jaundice, and serum transaminase levels and a 5 to 10 day shorter hospitalization period. Similar findings have been reported in adults with acute or chronic hepatitis treated with pangamic acid. 

The plasma half-life of 6-MP after intravenous bolus injection is 21 min in children and is twofold greater in adults. After oral intake peak levels are attained within 2 h. 6-MP is used for the treatment of ALL and has shown certain activity in chronic myelogenous leukemia. The major side effects involve myelosuppression, nausea, vomiting, and hepatic injury. 

This drug is contraindicated in patients with known hypersensitivity to die drug and during die first trimester of pregnancy (Category B). This drug is used cautiously in patients widi blood dyscrasias, seizure disorders, and hepatic dysfunction. Safety in children (odier dian orally for amebiasis) lias not been established. 

Chloroquine is contraindicated in patients with known hypersensitivity. It is a good idea to use chloroquine cautiously in patients with hepatic disease or bone marrow depression and during pregnancy. Children are very sensitive to chloroquine, and the drug should be used with extreme caution in children. 

The drugp used for gout are contraindicated in patients with known hypersensitivity. Probenecid is contraindicated in patients with blood dyscrasias or uric acid kidney stones and in children younger than 2 years. Sulfinpyrazone is contraindicated in patients with peptic ulcer disease and gastrointestinal inflammation. Colchicine is contraindicated in patients with serious gastrointestinal, renal, hepatic, or cardiac disorders and those with blood dyscrasias. 

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

Bortolotti F, Jara P, Barbera C, Gregorio GV, Vegnente A, Zancan L, Hierro L, CriveUaro C, Vergani GM, lorio R, Pace M, Con P, Gatta A (2000) Long term effect of alpha interferon in children with chronic hepatitis B. Gut 46 715-718... 

Hepatitis A virus (HAV) Naked icosahedra 27 nm in diameter Responsible for infectious hepatitis spread by the oro-faecal route especially in children. Also associated with sewage contamination of food or water supplies... 

Hepatitis B vaccine is recommended for routine use in children. The first dose should be given within 12 hours of birth. The second and third doses are given at 2 months and 6 months after the first dose if using the single component vaccine, or at 2, 4, and 6 months if using combination vaccines. If the infant weighs less than 2000 g at birth, the birth dose is not counted in the three-dose series. Infants less than 2000 g do not produce an adequate immune response to the birth dose of hepatitis B vaccine. Adolescents should receive the three-dose series if not previously vaccinated.6... 

Hepatic metabolism of ethanol involves a nonlinear saturable pathway. Young children have a limited ability to metabolize and thereby detoxify ethanol. Ethanol intoxication has been recorded in children with blood levels as low as 25 mg/dL. Alcohol has a volume of distribution of approximately 0.65 L/kg. Ingestion of 20 mL of a 10% alcohol solution will produce a blood level of 25 mg/dL in a 30 pound child. The American Academy of Pediatrics (AAP) Committee on Drugs recommends that pharmaceutical formulations intended for use in children should not produce ethanol blood levels of >25 mg/dL after a single dose. 

Chronic transfusion is indicated to prevent stroke and stroke recurrence in children. Transfusion frequency is usually every 3 to 4 weeks and should be adjusted to maintain HbS of less than 30% of total hemoglobin. The optimal duration is unknown. Risks include alloimmunization, hyperviscosity, viral transmission (requiring hepatitis A and B vaccination), volume and iron overload, and transfusion reactions. 

In children, primary immunization against tetanus is usually done in conjunction with diphtheria and pertussis vaccination using DTaP or a combination vaccine that includes hepatitis B and polio vaccines. A 0.5-mL dose is recommended at 2, 4, 6, and 15 to 18 months of age. 

Studies of non-cancer effects in children have indicated neurodevelopmental delays and neurobehavioural effects, including neonatal hypotonia. In children in Seveso who were highly exposed to TCDD, small, transient increases in hepatic enzymes, total lymphocyte counts and subsets, complement activity, and non-permanent chlo-racne were observed. Also, an alteration of the sex ratio (excess female to male) was observed in children born to parents highly exposed to TCDD. 

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