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Few reports describe oxysterols in healthy children or in children with liver disease. We aimed to determine whether developmental changes in urinary and serum oxysterols occur during childhood, and to assess whether oxysterols might be biomarkers for pediatric liver disease. Healthy children enrolled as subjects (36 and 35 for urine and serum analysis, respectively) included neonates, infants, preschoolers, and school-age children, studied along with 14 healthy adults and 8 children with liver disease. We quantitated 7 oxysterols including 4β-, 20(S)-, 22(S)-, 22(R)-, 24(S)-, 25-, and 27-hydroxycholesterol using liquid chromatography/electrospray ionization-tandem mass spectrometry. Urinary total oxysterols were significantly greater in neonates than in infants ( P  <  0.05 ), preschoolers ( P  <  0.001 ), school-age children ( P  <  0.001 ), or adults ( P  <  0.001 ), declining with age. Serum total oxysterols in neonates were significantly lower than in infants ( P  <  0.05 ), preschoolers ( P  <  0.001 ), school-age children ( P  <  0.05 ), or adults ( P  <  0.01 ). Compared with healthy children, total oxysterols and 24(S)-hydroxycholesterol in liver disease were significantly increased in both urine ( P  <  0.001  and  P  <  0.001 , respectively) and serum ( P  <  0.001  and  P  <  0.05 , respectively). Oxysterols in liver disease, particularly 24(S)-hydroxycholesterol, were greater in urine than serum. Oxysterols change developmentally and might serve as a biomarker for pediatric liver disease. To our knowledge, this is the first such report.

Urinary and serum oxysterols in children: developmental pattern and potential biomarker for pediatric liver disease