11. NEW PERSPECTIVES IN THE MORPHOLOGY OF NEONATAL HEPATI TIS (NH)

The morphology of NH as traditionally defined (Craig & Landing Arch. Pathol. 54:321, 1952; Witzleben - IAP Monograph 22:347, 1981) includes giant cell transformation, disruption of the hepatic plates, cholestasis, extramedullary hematopoiesis and hemosiderin accumulation. During the last 12 mos we have been impressed by the frequency of interlobular bile duct paucity in biopsies from cholestatic neonates at North Shore Univ.Hosp. with morphologic features of NH. Therefore, we reviewed liver biopsies from all 36 neonates with the dx. of NH not associated with extrahepatic biliary obstruction admitted to North Shore Univ.Hosp. or Babies Hosp., NY between 1975-1985. The specimens were examined by one observer (EK) without prior knowledge of the presence or absence of ductal changes. A minimum of 5 portal spaces/biopsy were required for inclusion in this study. By this criteria, 5 pts were excluded. Paucity of interlobular bile ducts, expressed by a ratio of bile ducts to portal spaces < 0.9, was present in 29/31 pts. 83% had a ratio < 0.6. Inflammation was absent in 27/29 spec.