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Infectious Complications in Pediatric Acute Liver Failure

Godbole, Gauri*; Shanmugam, Naresh; Dhawan, Anil; Verma, Anita*

Journal of Pediatric Gastroenterology and Nutrition: September 2011 - Volume 53 - Issue 3 - p 320–325
doi: 10.1097/MPG.0b013e318222b0cd
Original Articles: Hepatology and Nutrition

Objectives: Acute liver failure (ALF) is rare in children but carries high mortality. Infectious complications (IC) in adults are an important cause of mortality; however, there are few data in the pediatric population. The aim of the study was to determine the incidence of IC and their effects on the outcome in children with ALF.

Materials and Methods: The present study is a retrospective review of the case records of children presenting with ALF to our center. All patients with ALF received antibiotics and antifungal as prophylaxis from day 1 and high-dose acyclovir was given to neonates only (stopped when herpes simplex was ruled out). Biochemical parameters, duration of ventilation and intensive care, overall hospital stay, and patient outcome were compared between patients with IC and non-IC.

Results: A total of 145 children (78 boys), median (range) age 4.22 (1 day–16 years) years, were studied. Thirty-seven of 145 (25%) patients had proven IC. The predominant infections included 14 episodes of bacteremia in 13 patients and lower respiratory tract infection and urinary tract infection in 10 and 8 patients, respectively. IC occurred in patients after a median (range) duration of 16 (0–54) days of admission. Median (range) duration of hospital stay in patients with IC was 38 (1–201) days and was significantly higher than in those without IC (10 [1–74] days), P < 0.0001. Overall mortality was 21% (31), of which 7% (11) was from the IC group and 14% (20) from the non-IC group; the difference was not statistically significant.

Conclusions: Infections were more frequent after 2 weeks of admission. Patients with sepsis had longer hospital stays and prolonged ventilation. Invasive fungal infections were rare in pediatric ALF with adequate doses of antifungal prophylaxis.

*Department of Medical Microbiology

Pediatric Liver, GI & Nutrition Centre, Institute of Liver Studies, King's College Hospital, London, UK.

Address correspondence and reprint requests to Dr Gauri Godbole, MD, MRCP, Department of Medical Microbiology, King's College Hospital, London, UK (e-mail:

Received 17 September, 2010

Accepted 21 April, 2011

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN