title: The significance of isolated elevation of serum aminotransferases in infants and young children.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Pediatrics, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Bugeac
authors.forename: Avi
authors.initials: A
authors.lastname: Pacht
authors.forename: Hanna
authors.initials: H
authors.lastname: Mandel
authors.forename: Theodore
authors.initials: T
authors.lastname: Iancu
authors.forename: Ada
authors.initials: A
authors.lastname: Tamir
authors.forename: Isaac
authors.initials: I
authors.lastname: Srugo
authors.forename: Ron
authors.initials: R
authors.lastname: Shaoul
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000956:Antigens, Viral / Q000652:urine; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001942:Breast Feeding; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification; D005260:Female; D006008:Glycogen Storage Disease / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood*; D019564:Unnecessary Procedures
chemical_list: D000956:Antigens, Viral; D015415:Biomarkers; D000637:Transaminases; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase