Paediatric acute liver failure: a practical approach

Published:October 28, 2021DOI:https://doi.org/10.1016/j.paed.2021.10.002

      Abstract

      Acute liver failure (ALF) in the paediatric patient is a multisystem complex disorder, which occurs in the absence of chronic liver disease. Globally, viruses remain a common cause but drugs, metabolic and autoimmune conditions are important triggers. In up to half of cases no specific cause is identified. The definition entails a coagulopathy with a Prothrombin time (PT) ≥ 15seconds or International Normalized Ratio (INR) ≥ 1.5 not corrected by vitamin K in the presence of hepatic encephalopathy (HE) or a PT ≥ 20 or INR ≥2 or above regardless of HE. HE can be difficult to recognize in children and is defined differently than HE in adults. Timely recognition of ALF improves outcomes and allows time to undertake investigations, provide supportive therapy and arrange transfer to a specialist paediatric liver centre with transplant capacity. The purpose of this article is to review the aetiologies of ALF in children and outline an approach to investigation, management and treatment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Paediatrics and Child Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wendon J.
        • Cordoba J.
        • Dhawan A.
        • et al.
        EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure.
        J Hepatol. 2017; 66: 1047-1081
        • Squires R.
        • Shneider B.
        • Bucuvalas J.
        • et al.
        Acute liver failure in children: the first 348 patients in the paediatric acute liver failure study group.
        J Pediatr. 2006 May; 148: 652-658
        • Lee W.
        • Larson A.
        • Stravitz R.
        AASLD position paper: the management of acute liver failure.
        Hepatology. December 2011; (Update 2011)https://doi.org/10.1002/hep.25551
        • Taylor S.
        • Whitington P.
        Neonatal acute liver failure.
        Liver Transplant. 2016; 22: 677-685

      Further reading

        • Deep A.
        • Stewart C.
        • Dhawan A.
        • Douiri A.
        Effect of continuous renal replacement therapy in outcome in paediatric acute liver failure.
        Crit Care Med. 2016 Oct; 44: 1910-1919
        • Dhawan A.
        Etiology and prognosis of acute liver failure in children.
        Liver Transpl. 2008; 14: S80-S84
        • Lutfi R.
        • Abulebda K.
        • Nitu M.
        • Molleston J.
        • Bozic M.
        • Subbarao G.
        Intensive care management of pediatric acute liver failure.
        JPGN. 2017; 64: 660-670
        • Staufner C.
        • Hack T.
        • Kopke M.
        • et al.
        Recurrent acute liver failure due to NBAS deficiency: phenotypic spectrum, disease mechanisms, and therapeutic concepts.
        J Inherit Metab Dis. 2016 Jan; 39: 3-16
        • Sundaram V.
        • Shneider B.L.
        • Dhawan A.
        • et al.
        King's College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children.
        J Pediatr. 2013; 162 (e1): 319-323