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Imaging showed no structural abnormality. Over follow-up, transaminases\u2014alanine aminotransferase and aspartate aminotransferase\u2014rose, suggesting evolving hepatic involvement. Isolated GGT elevation, though uncommon, may represent the earliest clue to hepatobiliary disease. Heterozygous A1AT deficiency is not always benign and warrants ongoing biochemical surveillance. Clinicians should interpret guideline frameworks carefully to ensure atypical but clinically significant disease presentations are not overlooked.<\/jats:p>","DOI":"10.1136\/bcr-2025-271189","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:20:19Z","timestamp":1770049219000},"page":"e271189","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Isolated GGT elevation in prolonged neonatal jaundice: detection of heterozygous alpha-1 antitrypsin deficiency"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1837-7407","authenticated-orcid":false,"given":"Patrick","family":"Orji","sequence":"first","affiliation":[{"name":"Paediatrics, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabiha","family":"Asad","sequence":"additional","affiliation":[{"name":"Paediatrics, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heba","family":"Mansour","sequence":"additional","affiliation":[{"name":"Paediatrics, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"2026020208201062000_19.2.e271189.1","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/pch\/9.10.700","article-title":"Prolonged neonatal jaundice: When to worry and what to do","volume":"9","author":"Gilmour","year":"2004","journal-title":"Paediatr Child Health"},{"key":"2026020208201062000_19.2.e271189.2","doi-asserted-by":"crossref","first-page":"984","DOI":"10.18203\/2349-3291.ijcp20171712","article-title":"Different causes of prolonged unconjugated Jaundice in the newborns","volume":"4","author":"Agrawal","year":"2017","journal-title":"Int J Contemp Pediatr"},{"key":"2026020208201062000_19.2.e271189.3","doi-asserted-by":"crossref","unstructured":"Parvathamma P , Brockbank E , Abourahma Y . 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