Skip to Main Content

++

Liver failure is defined in adults by the requisite hallmarks of the presence of hepatic encephalopathy and uncorrectable coagulopathy within 8 weeks of the development of clinical jaundice, in the absence of known preexisting chronic liver disease. In children, a modified working definition for pediatric acute liver failure has been achieved by consensus of an expert panel (the Pediatric Acute Liver Failure [PALF] Study Group) as follows:

++

  1. 1. No known evidence of chronic liver disease.

    2. Biochemical evidence of acute liver injury.

    3. Hepatic-based uncorrectable coagulopathy defined as an international normalized ratio (INR) greater than or equal to 1.5 (approximate to a prothrombin time [PT] ⩾ 15 sec) in the presence of clinical hepatic encephalopathy OR (3a) an INR ⩾ 2.0 (approximate to PT ⩾ 20 sec) without hepatic encephalopathy.1

++

These modifications to the definition for pediatric acute liver failure notably recognize the difficulty of detecting hepatic encephalopathy, particularly the earlier stages, in infants and small children; markers of liver synthetic failure, such as an uncorrectable coagulopathy, as important indicators of liver failure even in the absence of hepatic encephalopathy; and children presenting in acute liver failure may in fact have a chronic liver condition not previously suspected or known. A clinical coma grade scale has been adapted for infants and children under the age of 4 years (Table 424-1).2

++
Table Graphic Jump Location
Table 424-1 Assessment of Encephalopathy for Young Children: Birth to Age 3 Years 
++

The approach to the child with acute liver failure should include the following: (1) establishment of an accurate diagnosis; (2) provision of intense, comprehensive medical supportive therapy; (3) anticipation, prevention, and timely treatment of complications, which may preclude the realization of spontaneous recovery; and (4) early referral to a liver transplant center, prior to the onset of complications of multiorgan failure, to assess both for indications and contraindications to liver transplantation. The causes of acute liver failure in children include a variety of age-dependent etiologies (Table 424-2). The diagnostic evaluations for these disorders is discussed elsewhere.

++
Table Graphic Jump Location
Table 424-2. Conditions Associated with Acute Liver Failure at Different Ages 

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.