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A raised ALP (alkaline phosphatase) level of 517 IU/L in a 4-week-old infant can be normal or physiological, but it should still be evaluated in the clinical context. Here's a breakdown of what it may indicate and what to do next in the UK setting.
🧪 Normal vs. Abnormal in Infants
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In newborns and infants, higher ALP levels are often normal due to:
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Bone growth (ALP is produced by osteoblasts)
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Liver immaturity
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Normal ALP range for neonates may be up to 500–600 IU/L or slightly higher, depending on the lab.
✅ When It's Likely Normal ("Physiological")
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Baby is feeding well, growing, and gaining weight appropriately
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No jaundice, vomiting, lethargy, or signs of illness
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No abnormal findings on other liver function tests (LFTs) (e.g., AST, ALT, bilirubin)
❗ When to Investigate Further
Consider further work-up if any of the following are present:
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Persistent jaundice
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Poor feeding or weight gain
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Other abnormal LFTs (ALT, AST, GGT, bilirubin)
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Bone abnormalities (fractures, rickets)
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Signs of liver disease or cholestasis
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Family history of metabolic or liver disorders
🩺 Next Steps (UK NHS Practice)
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Repeat ALP + full LFTs in 1–2 weeks if asymptomatic.
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If other abnormalities are found, consider:
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Liver ultrasound
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Bone profile (calcium, phosphate, vitamin D, PTH)
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Metabolic screen
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Referral to paediatrician or paediatric hepatology if concern persists.
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👶 Summary
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ALP 517 in a healthy, thriving 4-week-old is often physiological.
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Monitor growth and development.
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Repeat bloods or refer only if there are clinical concerns or abnormal associated labs.
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