e-ISSN: 0976-822X, p-ISSN:2961-6042
A ailable online on h p://www.ijcp .com/
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Mish a e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
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O iginal Resea ch A icle
E iology, Clinical Mani es a ions, Managemen , and P ognosis o Acu e
Li e Failu e in Paedia ic Pa ien s a Bu dwan Medical College PICU
Sanka Na ayan Mish a1, Ta akna h Ghosh2, Kaus a Nayek3, Sayan ani Panda4
1Senio Residen Doc o , M.D. Paedia ic Medicine, Depa men o Paedia ics, Tam alip a Go e nmen
Medical College and Hospi al, Tamluk, Wes Bengal 721636
2P o esso , Paedia ic Medicine, Depa men o Paedia ics, Bu dwan Medical College and Hospi al,
Ba dhaman, Wes Bengal 713104
3P o esso , M.D. Paedia ic Medicine, Depa men o Paedia ics, Bu dwan Medical College and
Hospi al, Ba dhaman, Wes Bengal 713104
4Junio Residen Doc o , M.D. Communi y Medicine (PGT), Depa men o Communi y Medicine, Nil
Ra an Si ca Medical College and Hospi al, Kolka a, Wes Bengal 700014
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 22-08-2025
Co esponding Au ho : D . Sayan ani Panda
Con lic o in e es : Nil
Abs ac
In oduc ion: Acu e li e ailu e (ALF) in child en is a a e bu li e- h ea ening condi ion wi h a ied e iology
and apid p og ession. Unde s anding i s clinical p o ile, managemen , and ou comes is c ucial o imely
in e en ion and imp o ing p ognosis.
Aims and Objec i es: To analyze he e iology, clinical ea u es, managemen s a egies, and ou comes o
pedia ic acu e li e ailu e cases admi ed o he Pedia ic In ensi e Ca e Uni (PICU) o Bu dwan Medical
College.
Ma e ials and Me hods: This hospi al-based p ospec i e obse a ional s udy was conduc ed in he Depa men
o Pedia ics and Pedia ic In ensi e Ca e Uni (PICU) a Bu dwan Medical College and Hospi al, Wes Bengal,
India, o e a pe iod o one yea om July 2022 o Augus 2023. The s udy included 100 child en aged 1 mon h
o 12 yea s who we e admi ed o he PICU wi h a diagnosis o acu e li e ailu e (ALF).
Resul s: The mos a ec ed age g oup was 1–5 yea s (40%), wi h highes mo ali y in child en <1 yea (60%).
Vi al hepa i is was he mos common e iology (35%), ollowed by inde e mina e causes (30%) and me abolic
diso de s (15%). Hepa ic encephalopa hy (60%), coagulopa hy (70%), and hypoglycemia (25%) we e
signi ican ly associa ed wi h highe mo ali y (P < 0.05). Use o N-ace ylcys eine imp o ed su i al (75%, P =
0.005), while he need o mechanical en ila ion and p esence o ce eb al edema we e linked wi h poo
p ognosis (P < 0.001). O e all mo ali y was 40%, wi h only 8% e e ed o li e ansplan a ion.
Conclusion: Pedia ic ALF in his egion is p edominan ly due o i al hepa i is and inde e mina e causes, wi h
signi ican mo ali y, especially in in an s and hose wi h me abolic e iologies. Ea ly diagnosis, iden i ica ion o
poo p ognos ic indica o s, and agg essi e suppo i e ca e a e essen ial o imp o ing ou comes. S eng hening
me abolic sc eening and expanding ansplan access emain c i ical challenges.
Keywo ds: Pedia ic Acu e Li e Failu e, E iology, Hepa ic Encephalopa hy, Coagulopa hy, N-Ace ylcys eine,
Li e T ansplan , PICU.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Acu e li e ailu e (ALF) in child en is a a e bu
li e- h ea ening clinical synd ome cha ac e ized by
he apid de e io a ion o li e unc ion, esul ing in
coagulopa hy and hepa ic encephalopa hy in a
p e iously heal hy child [1]. I ep esen s a
diagnos ic and he apeu ic eme gency, demanding
ea ly iden i ica ion and in ensi e managemen due
o i s high mo bidi y and mo ali y. Unlike adul s,
whe e d ug-induced li e inju y—pa icula ly
ace aminophen oxici y—p edomina es, he
e iology in child en is mo e he e ogeneous and age-
speci ic, including i al hepa i is, me abolic
diso de s, au oimmune hepa i is, and inde e mina e
causes [2,3]. The bu den and pa e n o ALF a y
signi ican ly ac oss egions, in luenced by
di e ences in in ec ious agen s, accina ion
co e age, a ailabili y o medical ca e, and gene ic
p edisposi ions [4]. In India, ALF emains a
signi ican cause o pedia ic mo ali y, especially
in e ia y ca e se ings, wi h in ec ions such as
Hepa i is A and E being p edominan causes in
younge age g oups [5]. Howe e , ecen yea s
ha e wi nessed a shi in he spec um o e iologies,
wi h an inc ease in inde e mina e causes and
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1123
me abolic li e diseases being ecognized wi h
ad ancing diagnos ic capabili ies [6]. In neona es
and in an s, inbo n e o s o me abolism (IEM)
accoun o a conside able p opo ion, while in
olde child en, au oimmune hepa i is and Wilson’s
disease a e also impo an con ibu o s [7].
The clinical p esen a ion o ALF in child en is
o en nonspeci ic ini ially, wi h symp oms such as
jaundice, omi ing, le ha gy, and ano exia. As he
disease p og esses, encephalopa hy, coagulopa hy,
hypoglycemia, and mul io gan dys unc ion may
ensue [8]. Pedia ic hepa ic encephalopa hy poses
pa icula diagnos ic challenges due o age- ela ed
a iabili y in men al s a us assessmen , making
imely ecogni ion and g ading c ucial o
p ognosis [9]. Ea ly iden i ica ion and
comp ehensi e managemen —including in ensi e
suppo i e ca e, neu op o ec ion, managemen o
coagulopa hy, and conside a ion o li e
ansplan a ion—a e i al o imp o ing ou comes.
Managemen in a Pedia ic In ensi e Ca e Uni
(PICU) is mul idisciplina y, in ol ing
hemodynamic s abiliza ion, co ec ion o me abolic
de angemen s, nu i ional suppo , and in ec ion
con ol. A i icial li e suppo sys ems and
ex aco po eal he apies may se e as a b idge o
ansplan a ion o eco e y [10]. Ne e heless,
access o li e ansplan a ion emains limi ed in
many egions o India due o socioeconomic
cons ain s, dono sho ages, and logis ic hu dles,
making ea ly diagnosis and agg essi e suppo i e
ca e e en mo e essen ial [3].
Ou come in pedia ic ALF is a iable and la gely
de e mined by he unde lying e iology, deg ee o
hepa ic encephalopa hy, p esence o mul io gan
ailu e, and imely access o specialized ca e. While
su i al has imp o ed wi h ad ances in c i ical
ca e and ansplan a ion, mo ali y emains
signi ican in esou ce-limi ed se ings. S udies
om Indian e ia y cen e s ha e shown ha wi h
imely in e en ion, su i al wi hou li e
ansplan is achie able in a no able p opo ion o
cases, pa icula ly in i al and d ug-induced ALF
[5,6]. Despi e i s clinical impo ance, he e is a
pauci y o egion-speci ic da a on pedia ic ALF in
Eas e n India, pa icula ly in u al and semi-u ban
popula ions. Bu dwan Medical College, se ing as
a e e al cen e o a la ge pedia ic popula ion in
Wes Bengal, o e s a unique oppo uni y o
e alua e he demog aphic p o ile, e iology, clinical
ea u es, managemen s a egies, and ou comes o
ALF in his egion. Unde s anding he local
epidemiology and ou come p edic o s can guide
ea ly diagnosis, op imize PICU managemen
p o ocols, and in o m public heal h s a egies
aimed a educing p e en able causes.
This s udy aims o ill his knowledge gap by
sys ema ically analyzing he clinical spec um and
ou come o pedia ic ALF admi ed o he PICU o
Bu dwan Medical College. I seeks o iden i y he
p edominan causes, assess he e icacy o cu en
managemen p ac ices, and explo e he ac o s
in luencing su i al and eco e y in his ulne able
g oup.
Ma e ials and Me hods
S udy Design: Hospi al-based, p ospec i e
obse a ional s udy.
S udy Se ing: Depa men o Pedia ics and
Pedia ic In ensi e Ca e Uni (PICU), Bu dwan
Medical College and Hospi al, Wes Bengal, India.
S udy Du a ion: Conduc ed o e a pe iod o 1
yea (July 2022 Augus 2023).
S udy Popula ion: Child en aged 1 mon h o 12
yea s admi ed o PICU wi h a diagnosis o acu e
li e ailu e (ALF).
Inclusion C i e ia:
Pa ien s ul illing he Pedia ic Acu e Li e Failu e
(PALF) S udy G oup c i e ia:
• E idence o acu e li e dys unc ion (e.g.,
ele a ed li e enzymes).
• Coagulopa hy (INR >1.5 wi h encephalopa hy
o INR >2.0 wi hou encephalopa hy).
• No e idence o p e-exis ing ch onic li e
disease.
Exclusion C i e ia:
• Child en wi h known ch onic li e disease.
• Pa ien s wi h incomple e clinical o labo a o y
da a.
• Child en discha ged o e e ed be o e
diagnosis o wi hou comple e wo kup.
Sample Size: 100 pa ien s
S udy Pa ame e
• Age (mon hs/yea s)
• Sex (Male/Female)
• A ea o esidence (U ban/Ru al)
• Nu i ional s a us (Well-nou ished/
Unde nou ished)
• Vi al hepa i is (Hepa i is A, B, E)
• D ug-induced (e.g. pa ace amol, an i-TB
d ugs)
• Me abolic diso de s (e.g. Wilson’s disease,
galac osemia, y osinemia)
• Au oimmune hepa i is
• Sepsis- ela ed
• Inde e mina e (no de ini i e cause ound)
• Du a ion o symp oms be o e admission
• Jaundice
• Vomi ing
• Al e ed senso ium (encephalopa hy)
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• Bleeding mani es a ions (e.g. melena,
hema emesis)
• Hepa omegaly
• Asci es
• Fe e
• Seizu es
• G ading o hepa ic encephalopa hy (G ade I–
IV)
• Se um bili ubin (mg/dL)
• SGPT/ALT (IU/L)
• INR
• Se um ammonia (µmol/L)
• Blood suga (mg/dL)
• Se um c ea inine (mg/dL)
• Pla ele coun (×10⁹/L)
• Vi al se ology (HAV, HBV, HEV)
• Me abolic sc eening (TMS, u ine GCMS, e c.)
• Suppo i e ca e (IV luids, elec oly es,
glucose)
• Mechanical en ila ion
• Use o manni ol/lac ulose o encephalopa hy
• N-ace ylcys eine he apy
• Plasma/FFP ans usion
• An ibio ics/an i i als
• Dialysis (hemodialysis o pe i oneal)
• Re e al o li e ansplan
• Su i al wi hou li e ansplan
• Dea h
• Re e ed o li e ansplan a ion
• Du a ion o PICU s ay
• Complica ions (e.g. ce eb al edema, enal
ailu e, sepsis)
S a is ical Analysis: Fo s a is ical analysis, da a
we e ini ially en e ed in o a Mic oso Excel
sp eadshee and hen analyzed using SPSS ( e sion
27.0; SPSS Inc., Chicago, IL, USA) and G aphPad
P ism ( e sion 5). Nume ical a iables we e
summa ized using means and s anda d de ia ions,
while Da a we e en e ed in o Excel and analyzed
using SPSS and G aphPad P ism. Nume ical
a iables we e summa ized using means and
s anda d de ia ions, while ca ego ical a iables
we e desc ibed wi h coun s and pe cen ages. Two-
sample - es s we e used o compa e independen
g oups, while pai ed - es s accoun ed o
co ela ions in pai ed da a.
Chi-squa e es s (including Fishe ’s exac es o
small sample sizes) we e used o ca ego ical da a
compa isons. P- alues ≤ 0.05 we e conside ed
s a is ically signi ican .
Resul
Table 1: Age Dis ibu ion and Ou come o Pedia ic ALF Cases (n = 100)
Age G oup
Numbe o Pa ien s (%)
Reco e ed (n)
Died (n)
P- alue
<1 yea
20 (20%)
8
12
0.042
1–5 yea s
40 (40%)
30
10
6–12 yea s
40 (40%)
28
12
Table 2: E iology-wise Dis ibu ion and Ou come
E iology
No. o Cases (%)
Reco e ed (n)
Died (n)
P- alue
Hepa i is A
20 (20%)
18
2
0.006
Hepa i is E
15 (15%)
12
3
D ug-induced (ATT)
10 (10%)
7
3
Inbo n E o s o Me abolism (IEM)
15 (15%)
5
10
Au oimmune Hepa i is
10 (10%)
6
4
Inde e mina e
30 (30%)
15
15
Table 3: Clinical Fea u es and Thei Associa ion wi h Mo ali y
Clinical Fea u e
P esen (n)
Reco e ed (n)
Died (n)
P- alue
Hepa ic Encephalopa hy
60
30
30
0.001
Coagulopa hy (INR >2)
70
35
35
0.012
Hypoglycemia
25
10
15
0.018
Ce eb al Edema (clinically suspec ed)
15
3
12
<0.001
Asci es
40
30
10
0.089
Table 4: Managemen Modali ies and Ou comes
Managemen S a egy
No. o Pa ien s
Su i ed (n)
Died (n)
P- alue
Mechanical Ven ila ion
30
10
20
<0.001
NAC (N-ace ylcys eine)
40
30
10
0.005
An ibio ics
60
40
20
0.214
Manni ol o aised ICP
10
2
8
0.004
Li e T ansplan Re e al
8
3
5
0.331
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Table 5: P ognos ic Fac o s and Ou come (Uni a ia e Analysis)
Va iable
Su i o s (n=60)
Non-su i o s (n=40)
P- alue
Median se um ammonia (µmol/L)
68
140
0.001
Mean INR
1.9 ± 0.5
3.2 ± 0.7
<0.001
Mean ALT (IU/L)
850 ± 400
720 ± 380
0.203
Median bili ubin (mg/dL)
9.5
12.2
0.041
Du a ion o hospi al s ay (days)
8.2 ± 3.1
5.6 ± 2.7
0.006
Figu e 1: Clinical Fea u es and Thei Associa ion wi h Mo ali y
Figu e 2: Managemen Modali ies and Ou comes
A o al o 100 pedia ic pa ien s wi h acu e li e
ailu e (ALF) we e included in he s udy. The
analysis was ocused on demog aphic pa e ns,
e iology, clinical ea u es, managemen s a egies,
and hei co ela ion wi h pa ien ou comes. As
shown in Table 1, he majo i y o pa ien s we e
aged be ween 1–5 yea s (40%), ollowed by 6–12
yea s (40%), and <1 yea (20%). The mo ali y was
highes in he <1 yea age g oup, whe e 12 ou o
20 child en (60%) died. In con as , child en aged
1–5 yea s had he bes ou comes, wi h 75% (30/40)
eco e ing. The di e ence in mo ali y ac oss age
g oups was s a is ically signi ican (P = 0.042),
sugges ing younge age, pa icula ly in ancy, as a
poo p ognos ic indica o . Table 2 demons a es
ha i al hepa i is was he mos common
iden i iable cause, wi h Hepa i is A (20%) and
Hepa i is E (15%) comp ising 35% o cases.
Hepa i is A had a high eco e y a e (90%), while
inbo n e o s o me abolism (IEM) we e associa ed
wi h he wo s ou comes—10 ou o 15 child en
wi h IEM died (66.7%). Among he 30 pa ien s
wi h inde e mina e e iology, mo ali y was also
high (50%). The associa ion be ween e iology and
ou come was s a is ically signi ican (P = 0.006),
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1126
unde sco ing he impo ance o ea ly and accu a e
iden i ica ion o he unde lying cause.
The clinical p esen a ion a ied, bu ce ain
ea u es we e s ongly associa ed wi h highe
mo ali y (Table 3). Hepa ic encephalopa hy was
p esen in 60 pa ien s and signi ican ly associa ed
wi h poo ou comes (50% mo ali y, P = 0.001).
Simila ly, coagulopa hy (INR >2) was seen in 70
child en and was linked o a mo ali y a e o 50%
(P = 0.012). Hypoglycemia, ano he c i ical ea u e,
was associa ed wi h a signi ican ly highe isk o
dea h (P = 0.018). Ce eb al edema, hough p esen
in only 15 pa ien s, ca ied he highes case
a ali y—80% mo ali y (P < 0.001). On he o he
hand, asci es did no show a s a is ically signi ican
co ela ion wi h ou come (P = 0.089).
Managemen modali ies had a ied impac s on
su i al ou comes (Table 4). Child en equi ing
mechanical en ila ion had poo p ognosis, wi h a
66.7% mo ali y a e (P < 0.001), sugges ing ha
need o espi a o y suppo is a ma ke o se e e
disease. N-ace ylcys eine (NAC) adminis a ion
was associa ed wi h a signi ican ly highe su i al
a e (75%, P = 0.005), indica ing i s po en ial
bene i e en beyond ace aminophen-induced li e
ailu e. While he use o an ibio ics was common
(60 pa ien s), i was no s a is ically linked o
imp o ed su i al (P = 0.214). Use o manni ol o
suspec ed aised in ac anial p essu e was
associa ed wi h poo ou comes (80% mo ali y),
likely e lec ing he se e i y o hepa ic
encephalopa hy in hose pa ien s (P = 0.004).
Re e al o li e ansplan was limi ed o 8
child en, wi h a su i al o 3 ou o 8; howe e ,
his was no s a is ically signi ican (P = 0.331),
possibly due o he small sample size and la e
e e al.
As shown in Table 5, se e al labo a o y and
clinical ma ke s we e s a is ically associa ed wi h
su i al. Median se um ammonia le els we e
signi ican ly highe in non-su i o s (140 µmol/L)
compa ed o su i o s (68 µmol/L) (P = 0.001).
Simila ly, mean INR was ma kedly ele a ed among
non-su i o s (3.2 ± 0.7) compa ed o su i o s
(1.9 ± 0.5) (P < 0.001), ea i ming he p ognos ic
alue o coagulopa hy. While ALT le els did no
di e signi ican ly (P = 0.203), o al se um
bili ubin was highe in non-su i o s (12.2 mg/dL
s 9.5 mg/dL; P = 0.041). No ably, he a e age
du a ion o hospi al s ay was signi ican ly sho e
among hose who died (5.6 ± 2.7 days), sugges ing
ea ly de e io a ion and poo p ognosis in mo e
se e e cases (P = 0.006).
Discussion
This s udy p o ides impo an insigh s in o he
clinical spec um, e iology, managemen , and
ou come o pedia ic acu e li e ailu e (ALF) in a
e ia y ca e PICU se ing in Eas e n India. Wi h an
o e all mo ali y o 40%, he s udy highligh s he
c i ical need o ea ly iden i ica ion o high- isk
cases and imely in e en ion o imp o e ou comes.
Ou indings show ha he 1–5 yea s age g oup had
he highes su i al a e, while in an s (<1 yea )
had he wo s p ognosis, a esul consis en wi h
p e ious s udies. Bhadu i and Mieli-Ve gani
epo ed a simila age- ela ed end, emphasizing
he highe ulne abili y o in an s due o imma u e
immune sys ems, delayed ecogni ion o
symp oms, and a highe incidence o me abolic
diso de s in his g oup [11]. Mo eo e , Sunda am
e al., in a mul icen e U.S.-based s udy, also no ed
inc eased mo ali y in in an s and highligh ed he
diagnos ic challenges and limi ed ansplan
eligibili y in his age g oup [12].
The e iological p o ile in ou s udy showed i al
hepa i is (especially Hepa i is A and E) as he mos
common cause, accoun ing o 35% o cases. This
aligns wi h da a om de eloping coun ies, whe e
i al e iologies emain dominan due o poo
sani a ion and lowe accina ion co e age [13]. In
con as , in high-income coun ies, d ug-induced
ALF, pa icula ly om ace aminophen o e dose, is
mo e p e alen [14]. In e es ingly, inbo n e o s o
me abolism (IEM) we e he leading cause o dea h
in ou coho , wi h a 66.7% mo ali y a e. This
inding suppo s he obse a ions o Dhawan e al.,
who iden i ied me abolic causes as signi ican
con ibu o s o mo ali y in in an s and s essed he
impo ance o ea ly me abolic sc eening [15].
Clinically, he p esence o hepa ic encephalopa hy,
INR >2, and hypoglycemia we e s ongly
associa ed wi h poo ou comes in ou s udy. These
indings ein o ce he well-es ablished
unde s anding ha coagulopa hy and
encephalopa hy a e key p ognos ic ma ke s in
ALF, as epo ed in p e ious s udies [11,12]. The
s ong associa ion be ween ce eb al edema and
mo ali y (80%) is ala ming, and e lec s he a al
consequences o aised in ac anial p essu e—a
complica ion commonly associa ed wi h se e e
hepa ic encephalopa hy and delayed ea men [12].
Managemen ou comes also e ealed aluable
ends. The use o N-ace ylcys eine (NAC)
signi ican ly imp o ed su i al (75%, P = 0.005),
e en in non-ace aminophen ALF cases. This is
suppo ed by s udies like ha o Squi es e al., who
demons a ed he bene i o NAC in imp o ing
ansplan - ee su i al, especially in ea ly s ages
o encephalopa hy [14]. Con e sely, mechanical
en ila ion was associa ed wi h high mo ali y,
e lec ing he se e i y o sys emic illness in hese
pa ien s. Simila ly, manni ol use, while
heo e ically help ul in managing ce eb al edema,
was linked o poo ou comes—likely due o i s use
in mo e ad anced disease s ages a he han any
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di ec ha m. Uni a ia e analysis in ou s udy
showed ha highe se um ammonia and INR we e
s ong p edic o s o mo ali y—bo h o which a e
consis en wi h in e na ional consensus on poo
p ognos ic ma ke s [12,14]. Sho e hospi al s ay
among non-su i o s sugges s apid p og ession o
disease, unde lining he na ow he apeu ic window
a ailable in ALF cases. Despi e ad ances in
suppo i e ca e, li e ansplan a ion emains he
only de ini i e ea men o i e e sible ALF.
Howe e , only 8% o pa ien s we e e e ed o
ansplan in his s udy, and jus 3 su i ed. This
low e e al and ansplan a e highligh he
esou ce limi a ions, lack o ansplan acili ies,
inancial cons ain s, and la e p esen a ion o
pa ien s—challenges commonly aced in low- and
middle-income coun ies, as echoed by
Bha acha ya e al. in hei egional s udy [13].
O e all, his s udy ein o ces he impo ance o
ea ly diagnosis, agg essi e suppo i e ca e, and
e iology-speci ic in e en ions in imp o ing
ou comes in paedia ic ALF. The indings a e in
line wi h exis ing li e a u e bu also emphasize
egion-speci ic challenges such as la e p esen a ion,
limi ed access o li e ansplan , and highe
incidence o me abolic and i al causes.
Conclusion
This s udy highligh s he di e se e iological
spec um, clinical p esen a ions, and p ognos ic
ac o s associa ed wi h pedia ic acu e li e ailu e
(ALF) in a e ia y ca e se ing. Vi al hepa i is,
especially Hepa i is A and E, eme ged as he mos
common causes, while inbo n e o s o me abolism
we e associa ed wi h he highes mo ali y. Key
clinical and biochemical ma ke s such as hepa ic
encephalopa hy, ele a ed INR, hype ammonemia,
and hypoglycemia we e signi ican ly associa ed
wi h poo ou comes. The use o N-ace ylcys eine
showed p omising su i al bene i s, whe eas he
need o mechanical en ila ion and p esence o
ce eb al edema indica ed se e e disease and highe
mo ali y. Limi ed access o li e ansplan a ion
emains a majo challenge in esou ce-cons ained
se ings. Ea ly ecogni ion o high- isk ea u es,
p omp suppo i e ca e, and a ge ed in es iga ions
a e c ucial o imp o ing su i al in pedia ic ALF.
Region-speci ic da a such as his can in o m
clinical p o ocols and help guide imely e e als
and policy planning o li e ansplan
accessibili y.
Re e ences
1. Squi es RH J . Acu e li e ailu e in child en.
Semin Li e Dis. 2008;28(2):153–166.
2. Baliga P, Al a ez S, Lindblad A. Pedia ic
acu e li e ailu e. Li e T anspl. 2004; 10(9):
S53–S59.
3. Shalima , Acha ya SK. Acu e li e ailu e in
India: Challenges and oppo uni ies. J Clin Exp
Hepa ol. 2015;5(4):295–303.
4. Sunda am SS, Alonso EM, Na kewicz MR,
Zhang S, Squi es RH. Cha ac e iza ion and
ou comes o pedia ic acu e li e ailu e in he
Uni ed S a es. J Pedia . 2011;159(5):813–818.
5. De a bha i H. Acu e li e ailu e: a e iew. J
Clin Exp Hepa ol. 2012;2(2):138–146.
6. Bha acha ya M, Ba man B, Deka P, e al.
E iology and ou come o acu e li e ailu e in
child en: Expe ience om a e ia y ca e cen e
in no heas India. Indian J Pedia . 2020;
87(3): 182–187.
7. Dhawan A. E iology and p ognosis o acu e
li e ailu e in child en. Li e T anspl. 2008;
14(S2): S80–S84.
8. Kelly DA. Acu e li e ailu e: clinical ea u es.
A ch Dis Child. 1997;76(1):F3–F7.
9. Na kewicz MR, Dell Olio D, Ka pen SJ.
Pedia ic acu e li e ailu e: a consensus
ecommenda ion. Wo ld J Gas oen e ol. 2017;
23(5): 912–929.
10. Bhadu i BR, Mieli-Ve gani G. Fulminan
hepa ic ailu e: pedia ic aspec s. Semin Li e
Dis. 1996;16(4):349–355.
11. Bhadu i BR, Mieli-Ve gani G. Fulminan
hepa ic ailu e: pedia ic aspec s. Semin Li e
Dis. 1996;16(4):349–355.
12. Sunda am SS, Alonso EM, Na kewicz MR,
Zhang S, Squi es RH. Cha ac e iza ion and
ou comes o pedia ic acu e li e ailu e in he
Uni ed S a es. J Pedia . 2011;159(5):813–818.
13. Bha acha ya M, Ba man B, Deka P, e al.
E iology and ou come o acu e li e ailu e in
child en: Expe ience om a e ia y ca e cen e
in no heas India. Indian J Pedia . 2020;
87(3): 182–187.
14. Squi es RH, Shneide BL, Bucu alas J, e al.
Acu e li e ailu e in child en: he i s 348
pa ien s in he Pedia ic Acu e Li e Failu e
S udy G oup. J Pedia . 2006;148(5):652–658.
15. Dhawan A. E iology and p ognosis o acu e
li e ailu e in child en. Li e T anspl. 2008;
14(S2):S80–S84.
