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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for jaundice in an infant

Answered by
Dr.
Dr. Pradeep Kumar

Pediatrician, Cardiology

Practicing since :2006

Answered : 1975 Questions

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Posted on Wed, 30 Sep 2015 in Liver and Gall Bladder
Question: Hi sir,

I am having a 3 months old daughter , who is suffering with jaundice(yellowish color eyes).We found this problem when her stools color was coming as white.Then we consulted a MD Gastroenterologist, who suggested us to get it done HIDA scan & biopsy. Biopsy report says no Bilirea atresia case , every thing is normal.Still doctor suggested us to undergo a surgery. We proceeded for that , but with the grace almighty every thing is fine , they have not done the surgery, just they opened and seen the condition and said that liver,galbladder every thing is OK.Only the thing some has strucked in galbladder and they flushed it.After that my daughter stools color got changed to yellowish color.After 15 days we repeated the LFT & GGT , then T.biluribin,SGPT & other levels gone up ; where as GGT level increased from 61(before flushing) to 73(now).Please advise us how to proceed further.

Thanks
XXXX
doctor
Answered by Dr. Pradeep Kumar 20 hours later
Brief Answer:
Get a repeat liver function test including GGT after 15 days

Detailed Answer:
Hello

Thanks for the query

I can understand your concern.I won't get worried for mild increase in GGT which is still in normal range(<124) if baby is doing well,color of stool is normal and there is no associated abnormality.Mild fluctuation in value of enzymes and bilirubin is normal during postoperative period.

I would like to get a repeat liver function test including GGT done after 15 days to reassess.

Please let me know if you have any more query.

Wishing for your child speedy recovery.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pradeep Kumar 4 minutes later
Thanks for your reply ,

Have u gone through the biopsy report , any thing serious in that report.Any further tests need to undergo. Please let me know.

Thanks
XXXX
doctor
Answered by Dr. Pradeep Kumar 30 minutes later
Brief Answer:
Please reattach the biopsy report

Detailed Answer:
Thanks for follow up

I am sorry,but I found only the GGT report.
I would request you to reattach the biopsy report along with other reports and also the prescription images if possible,so that I better able to help you out.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pradeep Kumar 4 minutes later
Sir,

Attached Biopsy report , please review and advise.

Thanks
XXXX
doctor
Answered by Dr. Pradeep Kumar 10 hours later
Brief Answer:
Report is suggestive of neonatal hepatitis

Detailed Answer:
I am sorry for delayed reply.

I have gone through the biopsy report.
Here I am trying to tell you something about jaundice for your better understanding.
The two most common causes of pathological jaundice in early infancy are Neonatal hepatitis and Extrahepatic biliary atresia.
Although the presentation of both these conditions are almost same,there are few things through which we can differentiate.
Liver biopsy,HIDA scan and operative cholangiogram these three are considered to be diagnostic.
All these have been done in your case and all are suggestive of diagnosis of neonatal hepatitis.
As you can see in the diagnosis of liver biopsy it is written that the findings are consistent with Giant cell hepatitis(Another name of neonatal hepatitis).
In more than 50 % of cases the exact cause of neonatal hepatitis could not be made(This is called Idiopathic).
Next most common cause is infective(mostly viral),which can be acquired from the mother and in most of the cases exact diagnosis of causative virus could not be made.(in last sentence of the report you can see that ADV(adenovirus)screening has been suggested.In this case no specific treatment is needed.Most of the babies recover over a period of time with some multivitamin and medium chain triglyceride supplementation.So no need of ADV screening.
Other less common causes are metabolic disorder or BSEP(bile salt export pump) deficiency.
High level of SGOT/SGPT and GGT are common in most of the causes except in BSEP deficiency.This is the reason in the report they have advised for BSEP immunostaining(Normal GGT as in your case).BSEP deficiency is uncommon in XXXXXXX and the out come is bad.It is less likely in your case as baby has started passing normal colored stool.

I would suggest you to keep your baby in regular follow up with serial investigations at interval of two to three weeks.If levels show a decreasing trend no need to worry or any further investigation.But if there is rising trend in the values I would suggest you to go for BSEP immunostaining to rule out BSEP deficiency.

I hope this helps.

Please let me know if you have any more doubts.
Wishing for your baby's speedy recovery.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pradeep Kumar 13 hours later
Dear Sir,

Thanks a lot for your elaborated explanation, Could you please let me know any famous child specialist to take medicines and all , to move further in surroundings of south XXXXXXX
And also GGT values should get decrease or increase , which is correct way.

Thanks
XXXX
doctor
Answered by Dr. Pradeep Kumar 24 minutes later
Brief Answer:
Dr XXXXXXX at Rainbow hospital XXXXXXX

Detailed Answer:
Thanks for writing back


You can consult Dr XXXXXXX at Rainbow hospital XXXXXXX or Dr M S Vishwanathan at Apollo XXXXXXX Both these are pediatric gasteroenterologist and I hope they will take care of your baby further.
I would suggest you to not to run behind GGT report.The overall management and prognosis depends on clinical condition and correlation between the various lab values like serum bilirubin,SGOT,SGPT,GGT,Alkaline phosphatase and many other.

So don't worry,consult a pediatric gasteroenterologist and follow his advice.
You can ask me further if there is any doubt and I shall be glad to help you out.

Wish your child good health.
Warm regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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