Introduction: Neonatal cholestasis is a common manifestation of various pathologies. These pathologies include direct
hepatocellular injury, defects in hepatocyte bile formation, or mechanical obstruction of bile flow. Histologically, most of the
biliary tract diseases, infections, genetic and metabolic diseases can display parenchymal inflammation leading to the diagnosis of
Neonatal Hepatitis (NH). Hence, NH implies a pattern of neonatal liver disease rather than a specific cause of liver injury. Among
non-obstructive causes, various viral infections are associated with NH. The unmasking of the etiology of NH in further patients’
management is extremely important. Also, the prevalence of viral associated NH varies among different studies. Therefore, we
planned to investigate the frequency of common viral agents in infants diagnosed with Idiopathic NH (INH).
Objective: A total of 138 consecutive infants with conjugated hyperbilirubinemia undergoing liver biopsy were collected as well
as thirty-one umbilical cord tissues belonging to normal infants as controls. Patients with known etiology of NH were excluded from
the study, and 74 cases diagnosed with INH were enrolled. Nucleic acid from the liver tissues of patients was extracted and real-time
PCR for the detection of EBV, CMV, HSV1, HSV2, and HHV6 was done.
Results: The mean age of the patients at the time of liver biopsy was 70 days (minimum: 22, maximum: 98 days). There were 36
males and 38 females. CMV DNA was detected in six patients and HHV6 DNA was detected in one patient, while all control tissues
were negative for the viral DNAs (p<0.05). None of the other tested DNA viruses could be detected in liver tissues. In addition, none
of the liver samples were positive for CMV inclusions in hepatocytes or biliary epithelium under the light microscope.
Conclusion: In conclusion, we found CMV DNA in six liver biopsies without any histological evidence of CMV infection. Using
more sensitive methods such as PCR is warranted to determine viral DNAs in the liver tissues and establish their role in the
development of NH. Further studies with larger populations should be conducted to provide more information regarding the role of
viruses in the development of NH and compare their frequency in different populations.