Abstract
Introduction
We evaluated the significance of low/normal serum gamma glutamyl transferase (GGT) level in infants with idiopathic neonatal hepatitis (INH).
Materials and methods
A retrospective review of the hospital records of 103 infants less than 3 months of age who were diagnosed with INH between August 1991 and November 2000 was performed. Variables including age at which jaundice was noticed, age at presentation, perinatal risk factors, family history of liver disease, parental consanguinity, initial ultrasound scan, liver biopsy, laboratory values at the first visit, the peak levels of total bilirubin, aspartate aminotransferase (AST), GGT and alkaline phosphatase (ALP) in the first 3 months of follow-up and interval for normalisation of serum bilirubin and AST were compared between infants presenting with low/normal GGT (≤100 U/L) and raised GGT (>100 U/L).
Results and discussion
Infants with low/normal GGT levels presented earlier (median 36.5 days versus 44 days; p=0.016) and had significantly higher bilirubin and AST levels at presentation (bilirubin 167.5 μmol/L versus 133 μmol/L; p<0.005 and AST 187.5 U/L versus 106 U/L; p<0.001) and at peak levels (bilirubin 170 μmol/L versus 146 μmol/L; p=0.024 and AST 210.5 U/L versus 129 U/L; p=0.001). A significant correlation was also found between GGT levels and serum albumin levels (p=0.004). Patients with low/normal GGT levels were more likely to have giant cell hepatitis on histology (p=0.015). There was no difference in time taken to recovery.
Conclusion
Low/normal levels of GGT in INH infants may be a predictor of more severe but recoverable disease.
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References
Ayling RM, Carragher F (2004) Neonatal biochemical reference ranges. In: Rennie JM (ed) Robertson’s textbook of neonatology, 4th edn. Elsevier, Oxford, England
Balistreri WF, Bezerra JA (2006) Whatever happened to “neonatal hepatitis”? Clin Liver Dis 10(1):27–53
Ballatori N, Truong AT (1995) Multiple canalicular transport mechanisms for glutathione S-conjugates. Transport on both ATP- and voltage-dependent carriers. J Biol Chem 270(8):3594–3601
Cabrera-Abreu JC, Green A (2002) Gamma-glutamyltransferase: value of its measurement in paediatrics. Ann Clin Biochem 39(Pt 1):22–25
Danks DM, Campbell PE, Jack I, Rogers J, Smith AL (1977) Studies of the aetiology of neonatal hepatitis and biliary atresia. Arch Dis Child 52(2):360–367
Dick MC, Mowat AP (1985) Hepatitis syndrome in infancy—an epidemiological survey with 10 year follow up. Arch Dis Child 60(6):512–516
Figlewicz DA, Delattre O, Guellaen G, Krizus A, Thomas G, Zucman J, Rouleau GA (1993) Mapping of human gamma-glutamyl transpeptidase genes on chromosome 22 and other human autosomes. Genomics 17(2):299–305
Goodman SI, Mace JW, Pollack S (1971) Serum gamma-glutamyl transpeptidase deficiency. Lancet 1(7692):234–235
Hammond JW, Potter M, Wilcken B, Truscott R (1995) Siblings with gamma-glutamyltransferase deficiency. J Inherit Metab Dis 18(1):82–83
Hermeziu B, Sanlaville D, Girard M, Léonard C, Lyonnet S, Jacquemin E (2006) Heterozygous bile salt export pump deficiency: a possible genetic predisposition to transient neonatal cholestasis. JPGN 42(1):114–116
Holloway PAH, Giles AM (2003) Reference intervals for biochemical data. In: Warrell DA, Cox TM, Firth JD, Benz EJ Jr (eds) Oxford textbook of medicine, 4th edn. Oxford University Press, Oxford, England
Jacquemin E, Lykavieris P, Chaoui N, Hadchouel M, Bernard O (1998) Transient neonatal cholestasis: origin and outcome. J Pediatr 133(4):563–567
Lockitch G, Halstead AC, Albersheim S, MacCallum C, Quigley G (1998) Age- and sex-specific pediatric reference intervals for biochemistry analytes as measured with the Ektachem-700 analyzer. Clin Chem 34(8):1622–1625
Maggiore G, Bernard O, Riely CA, Hadchouel M, Lemonnier A, Allagille D (1987) Normal serum gamma-glutamyl-transpeptidase activity identifies groups of infants with idiopathic cholestasis with poor prognosis. J Pediatr 111(2):251–252
Mieli-Vergani G, Howard ER, Mowat AP (1991) Liver disease in infancy: a 20 year perspective. Gut 32(Suppl):S123–S128
Moniz C, Nicolaides KH, Keys D, Rodeckt CH (1984) Gamma-glutamyl transferase activity in fetal serum, maternal serum, and amniotic fluid during gestation. J Clin Pathol 37(6):700–703
Moss D, Henderson R (1999) Clinical enzymology. In: Burtis CA, Ashwood ER (eds) Tietz textbook of clinical chemistry, 3rd edn. Saunders, Philadelphia, Pennsylvania
Priolisi A, Didata M, Fazio M, Gioeli RA (1980) Variations of the serum gamma-glutamyl transpeptidase activity in full-term and pre-term babies during their first two weeks of life. Minerva Pediatrica 32:291–296
Rojas E, Valverde M, Kala SV, Kala G, Lieberman MW (2000) Accumulation of DNA damage in the organs of mice deficient in gamma-glutamyltranspeptidase. Mutat Res 14(447):305–316
Soldin SJ, Savwoir TV, Guo Y (1997) Pediatric reference ranges for γ-glutamyltransferase (GGT) and urea nitrogen during the first year of life on the Vitros 500 analyzer. Clin Chem Suppl 43:S199
Soldin HJ, Hicks JM, Bailey J, Cook JF, Beatey J (1997) Pediatric reference ranges for γ-glutamyltransferase (GGT) on the Hitachi 747 analyzer. Clin Chem Suppl 43:S198
Stormon MO, Dorney SF, Kamath KR, O’Loughlin EV, Gaskin KJ (2001)The changing pattern of diagnosis of infantile cholestasis. J Paediatr Child Health 37(1):47–50
Taniguchi N, Ikeda Y (1998) Gamma-glutamyl transpeptidase: catalytic mechanism and gene expression. Adv Enzymol Relat Areas Mol Biol 72:239–278
Whitfield JB (2001) Gamma glutamyl transferase. Crit Rev Clin Lab Sci 38(4):263–355
Will Y, Fischer KA, Horton RA, Kaetzel RS, Brown MK, Hedstrom O, Lieberman MW, Reed DJ (2000) Gamma-glutamyltranspeptidase-deficient knockout mice as a model to study the relationship between glutathione status, mitochondrial function, and cellular function. Hepatology 32(4 Pt 1):740–749
Wright EC, Stern J, Ersser R, Patrick AD (1980) Glutathionuria: gamma-glutamyl transpeptidase deficiency. J Inherit Metab Dis 2(1):3–7
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Wang, J.S., Tan, N. & Dhawan, A. Significance of low or normal serum gamma glutamyl transferase level in infants with idiopathic neonatal hepatitis. Eur J Pediatr 165, 795–801 (2006). https://doi.org/10.1007/s00431-006-0175-3
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DOI: https://doi.org/10.1007/s00431-006-0175-3