Abstract:
Background: Neonatal jaundice and elevated levels of liver enzymes are found in infants with breast milk jaundice (BMJ).
Objectives: To determine the prevalence and duration of elevated serum levels of liver enzymes in Thai infants with
BMJ.
Methods: We conducted a prospective study of Thai infants with BMJ, excluding those with pathological causes
of jaundice. We measured the serum levels of total bilirubin (TB), aspartate aminotransferase (AST), alanine
aminotransferase (ALT), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT); followed infants with elevated
levels; and estimated the time for levels to become normal using Kaplan–Meier analysis.
Results: We included 42 infants (median age: 17.5 days) with BMJ, and elevated serum levels of at least 1 enzyme were
found in 27 (64%) infants. We excluded 4 (10%) infants because they did not continue to be exclusively breastfed, 17
(40%) were lost to follow-up, and 21 (50%) completed the study. We found that 19 (45%) of the 42 infants had elevated
GGT, 11 (26%) had elevated ALT, and 9 (21%) each had elevated AST and ALP levels. The median time for enzyme
levels to normalize was 291 days (95% confidence interval [CI], 109.8 to 472.2) for ALT, 240 days (95% CI, 139.0 to
340.9) for AST, 184 days (95% CI, 4.4 to 363.6) for ALP, 120 days (95% CI, 74.6 to 164.5) for TB, and 63 days (95%
CI, 61.44 to 64.6) for GGT. Infants were otherwise healthy during the follow-up.
Conclusion: The prevalence of elevated serum levels of liver enzymes in Thai infants was unexpectedly high, but the
levels became normal spontaneously despite continued breastfeeding, which endorses a “watchful waiting” strategy in
managing asymptomatic infants with BMJ
