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Prolonged, but transient, elevation of liver and biliary function tests in a healthy infant affected with breast milk

Dimitri Poddighe1, Lucia Castelli1, Gian Luigi Marseglia2

  • 1Department of Pediatrics, Ospedale di Circolo di Melegnano, Vizzolo Predabissi, Italy.

BMJ Case Reports
|May 30, 2014
PubMed

Insights

Neonatal jaundice, specifically breast milk jaundice, can unexpectedly elevate liver enzymes. In asymptomatic infants, prolonged monitoring is recommended over extensive testing for severe conditions.

Area of Science:

  • Neonatology
  • Pediatric Gastroenterology
  • Clinical Biochemistry

Background:

  • Unconjugated hyperbilirubinaemia is common in newborns and often requires investigation for underlying conditions.
  • Breast milk jaundice is typically benign, associated with breastfeeding, and lacks other clinical or laboratory abnormalities.

Observation:

  • A case of breast milk jaundice presented with unexpectedly elevated plasma liver and biliary enzymes.
  • The infant remained clinically well with appropriate growth despite abnormal liver function tests.

Findings:

  • Extensive investigations ruled out metabolic, infectious, and autoimmune liver diseases.
  • Liver function tests normalized spontaneously between 6-7 months of age.

Implications:

  • Suggests prolonged monitoring (6-7 months) for elevated liver enzymes in asymptomatic infants with breast milk jaundice.
  • Advocates for delaying sophisticated diagnostic investigations for unlikely severe diseases in such cases.

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