Elevated liver enzymes in 3 month old

[kmcbevia]

Our 3-month-old daughter has had trouble gaining weight since she about two weeks old (she gained her birthweight back fine, but since then has only gained about 1-3 ounces per week, albeit consistently.). The doctors have done bloodwork on her, and her ALT and AST consistently come back elevated. They've been in the 100s, went up to the 200s, then came down to the 90s and then went back up to the 100s. We've seen a ped GI and metabolic specialist, who did a ton of bloodwork and everything so far has come back negative for a metabolic disorder or anything infectious, like hepatitis. She's also had two ultrasounds, which indicate everything looks fine with her liver, gallbladder, etc.

The doctors are concerned and want to do a liver biopsy next. Aside from the liver enzymes and slow weight gain, our daughter seems completely healthy. She's alert, meeting developmental milestones, growing in terms of length. She seems to be eating ok. Can enzymes be elevated like this in infants and be normal? Should we do the biopsy? Any information would be helpful. Thanks!

[Kevin Pho, MD]

There has clearly been a comprehensive workup done.  The ultrasound and blood tests would rule out many of the major liver disorders.  

However, I agree that the biopsy is the next step in the face of negative results.  ALTs and ASTs in the hundreds are relatively high, and more serious liver causes - like an autoimmune etiology - needs to be ruled out.  

Another GI opinion can be considered if the diagnostic pathway isn't clear.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_