title: Prolonged, but transient, elevation of liver and biliary function tests in a healthy infant affected with breast milk jaundice.
abstract: Unconjugated hyperbilirubinaemia is a common finding in newborns. When it is exaggerated, it is usually investigated in order to exclude several diseases, such as newborn's haemolytic diseases, infections or hypothyroidism. Breast milk jaundice is a form of neonatal jaundice related to breast feeding and it is not usually associated with any clinical issue and/or other laboratory abnormalities. We describe a case of breast milk jaundice being associated, unexpectedly, to significant elevation of plasmatic liver and biliary enzymes. Despite the infant's good clinical condition and growth, several investigations were performed and these ruled out metabolic, infectious and autoimmune liver diseases. All liver function tests normalised by 6-7 months of life. We suggest that the finding of hypertransaminasaemia and hyper-γ-glutamyl transpeptidase in a benign clinical context (similar to what we described) should be followed for 6-7 months before performing sophisticated and expensive diagnostic investigations which aim at excluding some unlikely and severe diseases in a completely asymptomatic infant.
authors.affiliation: Department of Pediatrics, Ospedale di Circolo di Melegnano, Vizzolo Predabissi, Italy.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Poddighe
authors.affiliation: Department of Pediatrics, Ospedale di Circolo di Melegnano, Vizzolo Predabissi, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Castelli
authors.affiliation: Department of Pediatrics, IRCCS Policlinico Fondazione San Matteo, Pavia, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Marseglia
authors.affiliation: Department of Pediatrics, Ospedale di Circolo di Melegnano, Vizzolo Predabissi, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bruni
mesh_terms: D001659:Biliary Tract / Q000201:enzymology*; D001942:Breast Feeding; D003937:Diagnosis, Differential; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000201:enzymology*; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D008297:Male; D008895:Milk, Human; D000637:Transaminases / Q000097:blood*; D057832:Watchful Waiting; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000637:Transaminases