Characterization and outcomes of young infants with acute liver failure

Shikha S. Sundaram*, Estella M. Alonso, Michael R. Narkewicz, Song Zhang, Robert H. Squires

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

110 Scopus citations


Objective: To characterize infants aged ≤90 days enrolled in an international, multicenter, prospective registry of children aged <18 years with acute liver failure (ALF). Study design: The Pediatric Acute Liver Failure (PALF) Study Group collects prospective data on children from birth to 18 years. We analyzed data from infants aged ≤90 days enrolled in the PALF Study before May 18, 2009. Results: A total of 148 infants were identified in the PALF registry (median age, 18 days). Common etiologies of ALF were indeterminate (38%), neonatal hemochromatosis (13.6%), and herpes simplex virus (12.8%). Spontaneous survival occurred in 60% of the infants, 16% underwent liver transplantation, and 24% died without undergoing liver trsansplantation. Infants with indeterminate ALF were more likely to undergo liver transplantation than those with viral-induced ALF (P =.0002). The cumulative incidence of death without liver transplantation was higher in infants with viral ALF (64%) compared with those with neonatal hemochromatosis (16%) or indeterminate ALF (14%) (P = .0007). Conclusion: ALF in young infants presents unique diagnostic considerations. Spontaneous survival is better than previously thought. Liver transplantation provides an additional option for care.

Original languageEnglish (US)
Pages (from-to)813-818.e1
JournalJournal of Pediatrics
Issue number5
StatePublished - Nov 2011


  • ALF
  • ALT
  • APAP
  • AST
  • Acetyl-para-aminophenol
  • Acute liver failure
  • Alanine aminotransferase
  • Aspartate aminotransferase
  • INR
  • International Normalized Ratio
  • NH
  • Neonatal hemochromatosis
  • PALF
  • PT
  • Pediatric Acute Liver Failure Study
  • Prothrombin time

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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