Profile of children with fulminant hepatic failure of viral etiology admitted in a tertiary care hospital of north india

Back ground: Viral hepatitis is a major health problem endemic in all parts of the world including India. Fulminant hepatic failure occurs in about one percent of patients hospitalized with acute viral hepatitis. In children the predominant causative agent appears to be hepatitis A virus alone or in combination with other infectious agents .Keeping such patients in intensive care units has achieved survival rates upto 30-40 percent. There is a paucity of literature describing spectrum of fulminant hepatic failure in Indian children. Hence the present study was conducted to determine the pattern of fulminant hepatic failure in children of Punjab region.
Aims & Objectives: To determine the pattern of viral markers in children with fulminant hepatic failure of viral etiology and to correlate the clinical and biochemical profile with etiological agents.
Materials & Methods: This study was conducted on children aged 1-15 years admitted in a tertiary care hospital, in north Indian province of Punjab. This was a prospective study conducted over a time period of one and half year. Children of fulminant hepatic failure of viral etiology were only included.
Observations: In this study total of 30 children with fulminant hepatic failure of viral etiology were studied. Male to female ratio was 2.3:1.Hepatitis A was the commonest virus associated with fulminant hepatic failure. The prolonged jaundice at admission and greater time interval between onset of jaundice and onset of encephalopathy indicated poor prognosis. Mortality rate was 26.6 percent in our study. Non survivors as a group had significantly lower platelet counts. Majority of children were not vaccinated against hepatitis A.
Conclusions: Hepatitis A was the most common etiological agent in the cases of fulminant hepatic failure in children. As it is transmitted by feco-oral route, hand washing and proper hygiene especially while cooking will go a long way in keeping this virus away. Most importantly all children must be vaccinated against hepatitis A virus and this vaccine should be included in national immunization schedule. Timely ICU care will also save many a children with fulminant hepatic failure.