Acute Liver Failure in Neonates and Early Infancy: an Approach to Diagnosis and Management

Acute liver failure in neonates and early infancy is an uncommon condition with varied etiology and high mortality rates. We attempt to review the recent updates on the various causes, diagnostic approach, and specific management of acute liver failure in this unique population. Better diagnostic tools including genetic/molecular techniques have expanded our understanding of etiopathogenesis of neonatal/early infantile liver failure. Multidisciplinary team-led care and rapid arrival to diagnosis can lead to better outcomes. Neonatal/early infantile acute liver failure is a devastating condition with rapid progressive hepatocellular injury and poor prognosis compared to older children. Most common etiology includes neonatal hemochromatosis, viral hepatitis, and metabolic/genetic and ischemic causes. Structured approach to diagnostic evaluation with multidisciplinary team is needed for early diagnosis and the use of specific therapies. Liver transplantation remains a vital treatment, and prompt referral to a transplant center is crucial.