Objective: To describe the course of serum ALT and AST levels in infants with PA HIE during the first week, to evaluate differences in infants grouped by outcome, and to make clinico-pathologic correlations.

Methods: Retrospective cohort study. Patients fitted the conventional definition of severe PA-HIE. A subgroup had enzyme measures on day 1 and on day 2. Infants were grouped by outcome. AST and ALT measures were compared on days 1 and 2. Clinicopathologic correlation was evaluated in 11 patients.

Results: Of 173 consecutive admissions with PA HIE with known outcomes at age 12 months, 100 had measurements of AST or ALT (73 had both). 26 patients died, 32 had severe impairment, and 32 had no severe impairment. Enzyme levels varied greatly, no relationship to outcome was discerned(Table). Mean values (I.U.) for the subgroup are shown. AST leveled after day 1 and fell to normal values by day 5, ALT changes were slower. Enzyme levels did not predict pathology (2/7 false positive., 3/4 false negative.).

Table 1
Full size table

Conclusions: AST and ALT may have no role in predicting the outcome of asphyxia. In some cases, raised levels may reflect the efficiency of the diving reflex rather than the severity of hypoxia. The potential of AST/ALT for estimating the timing of injury may warrant a prospective study.