| Abstract | Neonatal liver failure, the failure of the synthetic function of the liver within 28 days of
birth, is relatively rare, but unfortunately carries a high mortality rate. There are many
different aetiologies of neonatal liver failure, ranging from haematological malignancies to
viral infections, from inborn errors of metabolism to drug toxicity. This case review will
explore neonatal liver failure due to gestational alloimmune liver disease as seen in three
patient families. In addition, prevention of gestational alloimmune liver disease in subsequent
pregnancies and the successful birth of healthy or gestational alloimmune liver diseaseunaffected
siblings to the parents of the aforementioned gestational alloimmune liver
disease-affected patients will be discussed. Family 1’s first born, soon after birth, showed
signs of acute liver failure. He received a partial liver transplant from his father, but despite all
efforts, died at five months of age from neonatal liver failure as a result of neonatal
haemochromatosis. The mother fell pregnant again and, in order to prevent gestational
alloimmune liver disease in the second pregnancy, received intravenous immunoglobulin
therapy. As a result, a female infant was born with minor complications, but was deemed
healthy soon afterwards. Family 2 had two previous children that had died, soon after birth,
from neonatal liver failure caused by neonatal haemochromatosis, in addition to two early
spontaneous abortions. While in her fifth pregnancy, the mother received intravenous
immunoglobulin treatment, and despite some initial mild hepatic dysfunction at birth,
following treatment with intravenous immunoglobulin and phototherapy, a healthy baby boy
was discharged soon after admission. Family 3’s first child was born prematurely and, at
birth, was in haemorrhagic shock due to jejunal perforation and apparent disseminated
intravascular coagulation. Despite all therapeutic and surgical interventions, the patient died
one month after birth. A year later, the mother fell pregnant and received preventative
intravenous immunoglobulin. Although the pregnancy was laden with complications, a
healthy male infant was born without any organ dysfunction. |
