title: Serum liver enzyme pattern in birth asphyxia associated liver injury.
abstract: OBJECTIVE
  To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA).
  
  
  METHODS
  Singleton term newborns with BA and ≤72 hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points.
  
  
  RESULTS
  Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy.
  
  
  CONCLUSIONS
  Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.
authors.affiliation: Department of Pediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Nanda
authors.initials: N
authors.lastname: Chhavi
authors.affiliation: Department of Pediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Zutshi
authors.affiliation: Department of Pediatrics, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Niranjan Kumar
authors.initials: NK
authors.lastname: Singh
authors.affiliation: Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Awasthi
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Goel
keywords: Asphyxia neonatorum; Hepatitis; Ischemia; Transaminases