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The significance of isolated elevation of serum aminotransferases in infants and young children

¹ Department of Pediatrics, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
² Department of Pediatrics, Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
³ Metabolic Unit, Meyer Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
⁴ Electron Microscopy Unit, Rappaport Faculty of Medicine, Technion, Haifa, Israel
⁵ Department of Community Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel

Correspondence to:
Dr Ron Shaoul, Pediatric Day Care Unit, Department of Pediatrics, Bnai Zion Medical Center, 47 Golomb St, POB 4940, Haifa 31048, Israel; shaoul_r{at}012.net.il

Introduction: The aim of this study was to assess the clinical significance and prognosis of a prolonged isolated elevation of serum aminotransferases without cholestasis (>3 months) in infants and young children, investigated for a variety of conditions, and to determine a protocol for their follow-up and investigation.

Methods: A combined prospective-retrospective analysis of apparently healthy babies and young children with isolated elevation of serum aminotransferases of at least 1.5 times above the norm for age which persisted for at least 3 months and whose creatine phosphokinase (CK), gamma glutamyltransferase (GGT), alkaline phosphatase and bilirubin levels remained normal throughout the study duration. The children underwent the following investigations: abdominal ultrasound and infectious, metabolic and/or immunological investigation depending on the duration of the abnormality.

Results: Six children were eliminated following the finding of positive cytomegalovirus (CMV) antigen in the urine. 72 children were investigated (47 males and 25 females). The duration of serum aminotransferases elevation was 3–36 months (average 12.4, median 11.5 months). The initial, maximal and final alanine aminotransferase (ALT) values were 85.5, 140.5 and 39.8 IU/l, respectively. Of seven children who had liver biopsies performed, three (42.8%) were suspected of having a glycogen storage disease which was not confirmed enzymatically. Four biopsies revealed non-specific histological changes.

Conclusions: Isolated elevation of serum aminotransferases in healthy looking young children is mostly a benign condition that usually resolves within a year. If no pathology is found during routine investigation, these children can be followed conservatively. Liver biopsy does not contribute much to the diagnosis and is probably unnecessary.