Serum transaminase activity in neonatal period: valuable and in differential diagnosis of jaundice in the newborn infant.

Abstract

Clinical and laboratory data have been obtained showing that the differential diagnosis of neonatal icterus is facilitated by serial measurements of transaminase activity of the serum. In 63 normal newborn infants the glutamic oxalacetic transaminase (GO-T) activity levels ranged from 13 to 120 units; for glutamic pyruvic transaminase (GP-T) the range was 12 to 90 units. In infants with neonatal icterus classified as physiological, transaminase activity remained within the normal range, and no correlation was found between the intensity of the icterus and the transaminase activity. Data from 15 infants (including previously published data on nine), with jaundice due to pathological conditions, indicate that characteristic patterns of enzyme activity appear for each of the varied causes of neonatal icterus. In infants with extrahepatic infection and usually in those with hemolytic conditions the enzyme activity remains within the normal range. However, in an infant with a fulminant form of hemolytic disease of the newborn, GO-T activity alone was transiently elevated to about 300 units. In all cases of biliary obstruction the GO-T and GP-T values rose gradually to levels below 800 units. In an infant with very mild acute hepatitis (homologous serum) the enzyme activity rose sharply during the stage of increasing hyperbilirubinemia to well above 800 units (to 1140 units) and fell sharply thereafter. Serial determinations of serum transaminase activity in cases of neonatal icterus, therefore, aid in recognition of patients requiring surgery.