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

BackgroundThe 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, pO2 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.AimsTo 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 designProspective 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 measuresAspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.ResultsNeonates 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).ConclusionsIn neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.