Letter to the Editor

Dr. Harris raises some interesting points about bilirubin metabolism in the fetus. She may be right in postulating that increased bilirubin production resulting in prehepatic overload is of importance in causing bile "sludge," an apt term. Hepatocellular damage may also play a role. We (pathologists) would not have thought that conjugation does not normally take place before birth. Meconium is green, and the gallbladder usually contains some bile, even in stillborns. The rate of conjugation may ordinarily be low, in part because the load of bilirubin is low, and a capacity to respond under abnormal conditions does seem, as Dr. Harris notes, to be present.