Clinical Profile, Etiology, and Outcomes of Acute Viral Hepatitis in Children: A Prospective Study at a Peripheral Tertiary Care Center

Abstract

Background: Acute viral hepatitis (AVH) remains a major pediatric health issue in developing countries. Managing AVH in peripheral tertiary care teaching hospitals serving rural communities presents distinct challenges due to limited access to advanced molecular diagnostics. This study evaluated the clinical profile, basic serological etiology (HAV and HBV), sonological findings, and management outcomes of pediatric AVH, accounting for patient disposition including transfers and dropouts.

Methods: A prospective observational study was initiated on 96 pediatric patients aged 1 to 15 years admitted with acute viral hepatitis to the Department of Pediatrics at Koppal Institute of Medical Sciences (KIMS), Koppal. Serological evaluation was focused on essential markers (IgM anti-HAV, HBsAg, and IgM ), Patients who took Discharge Against Medical Advice (DAMA, n=2) or required transfer to a higher super-specialty center for advanced liver support (n=4) were documented and excluded from final local outcome analysis. The remaining 90 patients who completed local treatment and follow-up were analyzed across three age groups (1–5, 6–10, and 11–15 years).

Results: Out of 96 total enrolled cases, 2 cases left against medical advice (DAMA) and 4 cases with progressive acute liver failure (ALF) were referred to a higher center for pediatric gastroenterology evaluation. Among the 90 patients analyzed for final outcome, 50 (55.6%) were boys and 40 (44.4%) were girls. Hepatitis A virus (HAV) was identified in 81 cases (90.0%) and Hepatitis B virus (HBV) in 9 cases (10.0%). Major presenting symptoms were jaundice (91.1%), dark urine (86.7%), anorexia (83.3%), vomiting (72.2%), and fever (66.7%). Pre-hospital traditional herbal medicine intake was noted in 61 cases (67.8%). Locally managed ALF developed in 6 cases (6.7%), all of whom recovered with supportive PICU care

Conclusions: Hepatitis A is the main cause of pediatric AVH in rural North Karnataka. Timely identification of severe illness allows appropriate early referral of high-risk cases to higher centers, while structured supportive care at the peripheral tertiary level achieves complete recovery for the majority of children.