Sir,We have read with great interest the recent article by Costa et al. [2]. However, we have some comments on it.The authors reported a case of subcapsular hepatic haematoma associated with a high level of alpha-foetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP. AFP levels were reported to be high (35,000 ng/mL vs a normal value of AFP at their hospital <13 ng/mL). A consistent decrease of AFP level was documented: AFP falls to 6,700 ng/mL three weeks later and was in the normal range after two months. However, we think that the AFP level of 35,000 ng/ml reported by Costa et al.[2] might be within the normal range for the neonatal period.In the study of Bader et al.[1], serum AFP concentrations were measured and characterised in 260 term and near-term newborns. Due to the wide range of AFP concentrations, it is useful to relate to a reference interval for AFP concentrations at birth that was 15,700-146,500 ng/ml, with a median value of 48,300 ng/ml. However, mean AFP concentrations at birth that were 61,600±44,800 ng/ml are less informative, due to the large standard deviation. At 60±24 h of life, AFP concentrations dropped to 9,700-111,900 ng/ml, with a median of 34,200 ng/ml. Riskin et al.[3] checked the umbilical cord AFP levels in 174 healthy full-term infants at birth. The mean umbilical cord AFP was found to be 60,200±45,900 ng/ml in their study. Likewise, the mean umbilical cord AFP was less informative due to the large standard deviation.Costa et al.[2] stated that a normal value of AFP at their hospital was <13 ng/mL [2]. This normal value might be acceptable for the childhood and adulthood period but not for the neonatal period. However, there is a wide variation in AFP concentrations in newborn infants [1,3]. Due to the wide range of AFP concentrations in healthy newborns, special precaution is required in interpreting high levels of AFP when liver diseases or congenital tumours are present in the early neonatal period. In these circumstances, the kinetics of the decline in AFP concentrations is more important than an absolute value.In conclusion, the AFP level of 35,000 ng/ml reported in the recent article by Costa et al.[2] might be within the normal range for the neonatal period.
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