Aim Presenting features and current status of children who presented with acute non-A-E hepatitis in a district general hospital

Method We looked at all cases of children (<16 yrs) who presented with acute hepatitis during March & April 2022. Presenting symptoms, clinical findings, level of transaminitis, presence of coagulopathy were noted. Investigations were based on the guidance issued by the RCPCH on acute non-A-E hepatitis during the same time period. Patients were discussed with the tertiary centre. After discharge patients were assessed monthly for the first 6 months and then 2 monthly where possible in the outpatient clinics.

Results 9 patients presented with transaminitis during a period which coincided with a spike in acute non-A-E hepatitis paediatric cases nationally. 77% of patients were females. The ages of patients ranged 2.5 to 6 years corroborating what has been observed nationally. .All patients had some gastrointestinal symptoms (anorexia, vomiting, loose stools or abdominal pain). 44% abdominal pain, 44% loose stools and 22% vomiting. 11% had lethargy and 55% were clinically jaundiced. 44% had acute liver failure either at presentation or during their admission. Two patients were readmitted after their initial admission episode because of worsening transaminitis trend. Surprisingly none had pruritus. Acute non-A-E hepatitis investigative work up as per RCPCH guidance was negative in all cases except finding the presence of Adenovirus & Enterovirus. 66% (6 patients) had PCR positive for Adenovirus and 11% (1 patient) for Enterovirus. On presentation 66% had hyperbilirubinemia and 33% presented coagulopathy. 66% were treated with Vitamin K but only 55% were managed with Urso-deoxycholic acid and fat-soluble vitamins. Only two patients needed transfer to the local tertiary hospital, rest were effectively managed locally

Conclusion Nationally there was a spike in children presenting with acute hepatitis. We had similar cases. Although only 66% cases have their transaminitis completely resolved, all children are asymptomatic and clinically well at the last clinical review. We hope our data supports other hospital findings and adds to the national database for future surveillance.