Prognostic implications of serum alpha-fetoprotein levels in neonatal hepatitis

Serum alpha-fetoprotein (AFP) values in 61 patients with neonatal hepatitis were compared with the normal ranges of AFP in infants and were expressed as standard deviation (SD) scores. The size of SD score indicates how many standard deviations the measured AFP value is away from the mean value of the normal population. An extremely elevated AFP value is arbitrarily defined as a SD score higher than 4.0, i.e., above mean + 4 SD. The result showed that rapid recovery from jaundice before 6 months of age occurred in 16 of 17 (94%) with SD scores of AFP lower than 4.0. By contrast, in 26 with SD scores of AFP higher than 4.0, 17 (65%) has less favorable clinical courses, either slow in recovery or progressing to chronic liver disease and even death. This correlation between AFP level and prognosis was related to the fact that higher AFP values were associated with more severe inflammatory changes in the liver, as assessed from either biochemical parameters (peak total and direct bilirubin levels) or histological findings (portal inflammation and giant cell transformation.