Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth

Abstract

Background: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals.

Aims: To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges.

Study design: Prospective cohort study, serum of umbilical artery (n=156) and vein (n=180), 599 normal singletons at 37(+0)-42(+0)weeks, neonates with IUGR (n=41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex.

Outcome measures: Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.

Results: Neonates with IUGR (n=41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI -1.98 to -1.00 vs 0.14, 95% CI -0.42-0.13), (p<0.001), (Fig. 3).

Conclusions: In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.