Slow weight gain and elevated liver enzymes (ALT/AST)

[kmcbevia]

Hi,

My name is Kristin, and I'm new to the board. My husband and I have two little ones (Isabel, 3 yrs, and Sofia, 3 months).

I was wondering if anyone else has had a baby who gained weight slowly and also had elevated liver enzymes (ALT/AST). And if so, whether the enzymes eventually came down or not.

This post is pretty long and rambling. Pls forgive. It's just I have a lot on my mind.

Little Sofia started out big -- she was 9 lbs, 11 oz at birth, but now at a little over 3 months, weighs only 11 lbs, 7 oz. Some weeks she gains 1 ounce, sometimes 3, and sometimes none. We've had a few weeks where she gains more -- last week, for instance, she gained 5 ounces. But they're far and few between. I can't say I see a huge difference in her feeding style, week to week.

She was a sleepy baby for the first six weeks or so, and I had to wake her for feedings at night, for instance. I've pretty much run the gamut in terms of trying to find ways to bulk her up -- met with a lactation consultation, took fenugreek, pumped milk and gave it to her first with a supplemental feeder, then a syringe (because she kept pulling the feeder off), and now finally a bottle (we've really had a hard time getting her to take one.) I also supplement with formula (I was dead-set against it for a long time, but now I'm just so desperate for her to put on some weight.) My milk supply, at least in terms of volume, doesn't seem to be the issue. When I pump, I have enough milk. The lactation consultant told me the latch seemed fine. And she poops and pees regularly. I also sucessfullyi nursed her big sister for close to 3 years.

After a few weeks of Sofia not gaining much weight, I agreed to let the doctor run a metabolic panel on her. Everything came back fine, but her liver enzymes (ALT/AST) were elevated, in the 100s and then 200s. They came back down for a bit -- still in the abnormal range -- but then went up again. She has since had several blood tests done to search for metabolic disorders and infectious causes, and so far everything has come back negative. She's also had two ultrasounds and both times her liver and everythiing else looked fine. Developmentally she seems right on target -- she's happy, alert, holds her head up, can roll over. And she's growing lengthwise (she's long and skinny). She also cues more to eat now, and seems to eat well -- my breasts are usually empty afterward, and if i feed her pumped milk or a bottle of formula, she'll eat 3-5 ounces at a time. No spit up issues and she's never had jaundice.

But now the pediatric GI specialist is pushing us to have a biopsy on her liver. She insists that there must be something more going on, or her liver enzymes wouldn't be up. (By the way, I take no medications and even stopped the fenugreek, once we established it wasn't an issue of my milk supply.) I'm torn, on one hand, I of course would want to know sooner rather than later if there is something wrong with her liver.


But I also don't want to put her through something so major as a liver biopsy prematurely. In every aspect except for the weight gain, Sofia seems happy and healthy. It seems like a lot of times people's doctors don't even do a blood workup if the baby seems healthy and developmentally on target. They just say the baby is skinny and let it go at that. I can't help but wonder sometimes if maybe her lilttle liver is just getting a slow start in life and things might work out on their own. But maybe that's just wishful thinking. In other words, I don't know whether to think the doctors are being proactive in a good way or overly alarmist.

If anyone out there has experienced something similar, or can share any other insights related to liver enzymes and infant wieght gain, I'd love to hear from you. Thanks much.

Kristin

[carpentergirl]

hi, and welcome to the forum! I'm sorry your having problems, it has to be frightening; facing a potential biopsy. It seems like you've done what you can to make your LO healthy, and I commend your dedication to breast feeding. I haven't experienced what you are going through, but I'll be thinking of you.
Have you contacted your local La Leche Leader for information? Sometimes they can hook you up with someone who has had a similar experience.hth

[divinedimension]

Hi,

My name is Kristin, and I'm new to the board. My husband and I have two little ones (Isabel, 3 yrs, and Sofia, 3 months).

I was wondering if anyone else has had a baby who gained weight slowly and also had elevated liver enzymes (ALT/AST). And if so, whether the enzymes eventually came down or not.

This post is pretty long and rambling. Pls forgive. It's just I have a lot on my mind.

Little Sofia started out big -- she was 9 lbs, 11 oz at birth, but now at a little over 3 months, weighs only 11 lbs, 7 oz. Some weeks she gains 1 ounce, sometimes 3, and sometimes none. We've had a few weeks where she gains more -- last week, for instance, she gained 5 ounces. But they're far and few between. I can't say I see a huge difference in her feeding style, week to week.

She was a sleepy baby for the first six weeks or so, and I had to wake her for feedings at night, for instance. I've pretty much run the gamut in terms of trying to find ways to bulk her up -- met with a lactation consultation, took fenugreek, pumped milk and gave it to her first with a supplemental feeder, then a syringe (because she kept pulling the feeder off), and now finally a bottle (we've really had a hard time getting her to take one.) I also supplement with formula (I was dead-set against it for a long time, but now I'm just so desperate for her to put on some weight.) My milk supply, at least in terms of volume, doesn't seem to be the issue. When I pump, I have enough milk. The lactation consultant told me the latch seemed fine. And she poops and pees regularly. I also sucessfullyi nursed her big sister for close to 3 years.

After a few weeks of Sofia not gaining much weight, I agreed to let the doctor run a metabolic panel on her. Everything came back fine, but her liver enzymes (ALT/AST) were elevated, in the 100s and then 200s. They came back down for a bit -- still in the abnormal range -- but then went up again. She has since had several blood tests done to search for metabolic disorders and infectious causes, and so far everything has come back negative. She's also had two ultrasounds and both times her liver and everythiing else looked fine. Developmentally she seems right on target -- she's happy, alert, holds her head up, can roll over. And she's growing lengthwise (she's long and skinny). She also cues more to eat now, and seems to eat well -- my breasts are usually empty afterward, and if i feed her pumped milk or a bottle of formula, she'll eat 3-5 ounces at a time. No spit up issues and she's never had jaundice.

But now the pediatric GI specialist is pushing us to have a biopsy on her liver. She insists that there must be something more going on, or her liver enzymes wouldn't be up. (By the way, I take no medications and even stopped the fenugreek, once we established it wasn't an issue of my milk supply.) I'm torn, on one hand, I of course would want to know sooner rather than later if there is something wrong with her liver.


But I also don't want to put her through something so major as a liver biopsy prematurely. In every aspect except for the weight gain, Sofia seems happy and healthy. It seems like a lot of times people's doctors don't even do a blood workup if the baby seems healthy and developmentally on target. They just say the baby is skinny and let it go at that. I can't help but wonder sometimes if maybe her lilttle liver is just getting a slow start in life and things might work out on their own. But maybe that's just wishful thinking. In other words, I don't know whether to think the doctors are being proactive in a good way or overly alarmist.

If anyone out there has experienced something similar, or can share any other insights related to liver enzymes and infant wieght gain, I'd love to hear from you. Thanks much.

Kristin

Sometimes, in a case with elevated liver enzmes, there could be other things going on as opposed to the liver itself. The liver works in conjunction with the gallbladder, pancreas and even the kidneys. Has the baby been checked for any other conditions that have to do with the functions of the above mentioned organs? If all else seems fine, I wouldn't put your child through this procedure. She's certainly not at the top of the charts with weight gain, but give it some time. Other symptoms will develop that show you more, if indeed this is an indicator of trouble on the horizon. How is her length/height and head circumference? This could be a better indicator of growth than weight alone. Perhaps give it some time (another month tops) to see if her heights/length and head circumference get better. If not, then get another opinion and THEN finally get the biopsy. But until there is more to work with, keep in mind that a liver biopsy is VERY painful and may make the baby bleed internally. I'd hold off if I were you. Listen to your instincts tho, a mother's instincts never fail.

[LLL_Rebecca]

Hi Kristin, welcome to the boards, and congratulations on your new baby Sofia.

What a worrisome situation! Chronic slow weight gain with no discernible reason despite changes in feeding management and despite good diaper output ... and a consistently abnormal lab result (the elevated liver enzyme) -- sounds like just enough information to make you worry but not nearly enough to know what to do next.

This is well beyond the expertise of a LLL Leader, so I'm afraid I have no helpful information for you at all. I will ask a moderator to move this thread to the Chronic Health Concerns board for babies, though, in hopes of catching the eye of a mother who went through something similar or who has more specialized information for you.

I will ask one question: when you started supplementing with formula, did you see any improvement in either weight gain or in the liver enzymes?

If not, then you might want to consider returning to exclusive breastfeeding to see how that goes. There are certain benefits provided by exclusive breastfeeding, primarily in terms of immune system functioning. Sometimes a breastfed baby or young child who has contracted a serious disease or disorder will be overall much healthier than anyone expects. Breastfeeding doesn't cure such diseases, but it can minimize their impact or help to prevent secondary infections etc.

This is pure guesswork on my part, however; I urge you to work with Sofia's health care providers and your IBCLC in making any major decisions about how to move forward. I hope you will soon have answers and peace of mind.

[kmcbevia]

Thank you everyone for your responses. I really appreciate it.

Rebecca, can you pls tell me where I can find the Chronic Health Concerns section? I couldn't find it.

I just started supplementing with formula about a week and a half ago, so I don't have a good sense of her weight gain yet. Though she did gain 5 ounces last week, so hopefully that is a good sign. But that could be due to the bottle, as opposed to the formula itself. (She just now started taking one; it's been quite the struggle.) I'm giving her one bottle of formula per day. The rest is direct nursing or pumped breast milk. I'm aiming for about 30 ounces/day. They'll probably recheck her enzymes tomorrow as well, so I'll have a sense if that helps. And thank you for the reminder of the immunological benefits to breast milk. I'm pretty dedicated to sticking it out. I don't know that I'll be able to EBF, like I did with my first daughter, but I would still like for it to be majority of what Sofia takes in.

I'm pretty sure they've checked the other organs as well, but thank you for mentioning that. I will talk with the doctors about it. We are planning to get a second, and maybe even a third opinion, before going on with the biopsy. I too want to give it a little more time. As for her height and head circumference, she's been growing fine. She was 20 inches at birth and is now 23 3/4 inches. I'm not sure of her head size, but I know it's doing fine.

I'll try to contact my local La Leche leader, to see if she knows of anyone who's gone through something similar. And maybe to get a second opinion on latch and feeding technique. It's just, if she starts to gain weight with the bottle -- which I'll be thrilled with -- it will make me question whether or not there was indeed an issue with the nursing itself. With my first daughter, it all came pretty effortlessly and I was fortunate not to have any feeding issues. It's hard to have this not be this case with Sofia.

Thank you again, everyone.

Best,

Kristin

[LLL_Rebecca]

Rebecca, can you pls tell me where I can find the Chronic Health Concerns section? I couldn't find it.

Here -- http://forums.llli.org/forumdisplay.php?f=58

It's just, if she starts to gain weight with the bottle -- which I'll be thrilled with -- it will make me question whether or not there was indeed an issue with the nursing itself.

That would be a reasonable question! And frankly, I'm sure you'd rather there be an issue with your nursing relationship than with your daughter's underlying health. So I agree you should not rule out the sort of breastfeeding issues that more typically lead to slow weight gain -- and we'll be happy to talk you through those concerns if that will be helpful.

I sent a private message to the moderator just now; she may move this thread to the Chronic Conditions -- Baby board, but if you like you may go ahead and post there as well. HTH!

[kmcbevia]

Thanks, Rebecca. I just posted it myself, over on the other forum. Thank you again. And I will definitely be back for advice on nursing issues, if the bottle turns out to improve things.