European Journal of Pediatrics

, Volume 150, Issue 5, pp 310–313 | Cite as

Abnormal results of biochemical liver function tests in breast-fed infants with prolonged indirect hyperbilirubinaemia

  • Y. Tazawa
  • D. Abukawa
  • M. Watabe
  • M. Nakagawa
  • M. Yamada


To clarify the relationship between hyperbilirubinaemia and abnormal results of biochemical liver function tests in infants with breast milk jaundice (BMJ), 58 breast-fed infants with indirect hyperbilirubinaemia were enrolled in this study. Sera obtained from the above infants were subjected to routine liver function tests. Although serum transaminases were within normal limits in all 58 patients, serum alkaline phosphatase levels were abnormally increased in 13, gamma-glutamyltranspeptidase in 8 and total bile acids in 11 out of all patients examined. A total of 18 (31%) patients had abnormal results in at least one item of the liver function tests. The intrinsic bile acid loading test showed postprandial increases in bile acids in 5 of 16 (31%) patients examined at either 60 or 120 min, while all 13 breast-fed, agematched controls had no abnormal results. The decrease in rate of serum bilirubin levels after the 3-day discontinuation of breast-feeding was significantly less in patients with increased fasting bile acids than in patients with normal fasting levels of serum bile acids. These results may suggest that mild hepatic dysfunction or cholestasis is associated with indirect hyperbilirubinaemia in some infants with BMJ.

Key words

Breast milk jaundice Liver dysfunction Cholestasis 



alkaline phosphatase


breast milk jaundice




glutamic oxalacetic transaminase


glutamic pyruvic transaminase


total bile acids


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arias IM, Gartner LM, Seifter S, Furman M (1964) Prolonged neonatal unconjugated hyperbilirubinemia associated with breast feeding and a steroid, pregnane-3(alpha), 20(beta)-diol, in maternal milk that inhibits glucuronide formation in vitro. J Clin Invest 43:2037–2047Google Scholar
  2. 2.
    Bevan BR, Holton JB (1972) Inhibition of bilirubin conjugation in rat liver slices by free fatty acids, with revalence to the problem of breast milk jaundice. Clin Chim Acta 41:101–107Google Scholar
  3. 3.
    Délèze G, Paumgartner G (1977) Bile acids in serum and bile of infants with cholestatic syndromes. Helv Paediatr Acta 32: 29–38Google Scholar
  4. 4.
    Finni K, Similä S, Koivisto M, Hsikura S, Ala-Houhala M (1982) Cholic acid. chenodcoxycholic acid, alpha-fetoprotein and alpha-1-antitrypsin serum concentrations in breast-fed infants with prolonged jaundice. Eur J Pediatr 138:53–55Google Scholar
  5. 5.
    Gartner LM, Arias IM (1966) Studies of prolonged neonatal jaundice in the breast-fed infant. J Pediatr 68:54–66Google Scholar
  6. 6.
    Gartner LM, Lee KS, Moscioni AD (1983) Effects of milk feeding on intestinal bilirubin absorption in the rat. J Pediatr 103:464–471Google Scholar
  7. 7.
    Goresky CA (1975) The hepatic uptake process: its implications for bilirubin transport. In: Goresky CA, Fisher MM (eds) Jaundice. Plenum, New York, pp 159–174Google Scholar
  8. 8.
    Gourley GR, Arend RA (1986) β-glucuronidase and hyperbilirubinemia in breast-fed and formula-fed babies. Lancet I: 644–646Google Scholar
  9. 9.
    Javitt NB, Keating JP, Grand RJ, Harris RC (1977) Serum bile acid patterns in neonatal hepatitis and extrahepatic biliary atresia. J Pediatr 90:736–739Google Scholar
  10. 10.
    Newman AJ, Gross S (1963) Hyperbilirubinemia in breast-fed infants. Pediatrics 32:995–1001Google Scholar
  11. 11.
    Odell GB, Javitt NB, Cukier JO, Maglalang A, Kok E (1975) Neonatal jaundice and cholestasis. Gastroenterology 69:851Google Scholar
  12. 12.
    Stiehm ER, Ryan J (1965) Breast-milk jaundice. Am J Dis Child 109:212–216Google Scholar
  13. 13.
    Tazawa Y, Yamada M, Nakagawa M, Konno T, Tada K, Ohi R, Kasai M (1983) Comparative determinations of serum lipoprotein-X and serum bile acid for screening for biliary atresia. In: Kasai M (ed) Biliary atresia and its related disorders. Excerpta Medica, Amsterdam, pp 121–124Google Scholar
  14. 14.
    Tazawa Y, Yamada M, Nakagawa M, Konno T, Tada K (1985) Serum bile acids and their conjugates in breast-fed infants with prolonged jaundice. Eur J Pediatr 144:37–40Google Scholar
  15. 15.
    Yamada M, Tazawa Y, Nakagawa M, Konno T, Tada K, Goto J, Nambara T (1985) Alternations of serum bile acid profile in breast-fed infants with prolonged jaundice. J Pediatr Gastroenterol Nutr 4:741–745Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Y. Tazawa
    • 1
  • D. Abukawa
    • 2
  • M. Watabe
    • 2
  • M. Nakagawa
    • 2
  • M. Yamada
    • 3
  1. 1.Department of PaediatricsAkita University School of MedicineAkitaJapan
  2. 2.Department of PaediatricsTohoku University School of MedicineSendaiJapan
  3. 3.Department of Neonatal Intensive Care UnitSendai Red Cross HospitalSendaiJapan

Personalised recommendations