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Hyperbilirubinemia in the Newborn

What is hyperbilirubinemia in the newborn?

Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.

Bilirubin is made by the breakdown of red blood cells. It’s hard for babies to get rid of bilirubin. It can build up in their blood, tissues, and fluids.

Bilirubin has a color. It makes a baby’s skin, eyes, and other tissues to turn yellow (jaundice). Jaundice may first appear when your baby is born. Or it may also show up any time after birth.

What causes hyperbilirubinemia in the newborn?

During pregnancy, the placenta removes bilirubin from your baby’s blood. When a baby is born, the baby's liver takes over this job. Your baby may have too much bilirubin for many reasons.

Physiologic jaundice

During the first few days of life, babies aren’t able to get rid of much bilirubin. This type of jaundice happens as a response to a baby’s reduced ability to remove bilirubin.  

Breastfeeding failure jaundice

Many babies don’t breastfeed well at first. This causes breastfeeding failure jaundice. Not feeding well makes your baby dehydrated. It also causes your baby to urinate less. This makes bilirubin build up in your baby’s body. Babies born between weeks 34 to 36 of pregnancy are more likely to get this problem. These babies often don’t have the coordination and strength to breastfeed well. But this condition is also common in full-term newborns. It usually gets better once a baby learns how to breastfeed well.

Breastmilk jaundice

About 1 in 50 breastfed babies get jaundice. This happens during their first week of life. It peaks at about 2 weeks of age. It can last 3 to 12 weeks. This issue may be caused by a substance in breastmilk. This substance may increase how much bilirubin the baby's body can reabsorb.  

Jaundice from hemolysis

If your baby has Rh disease (hemolytic disease of the newborn), he or she may get this type of jaundice. This issue can also be from having too many red blood cells. These cells can break down and release bilirubin.

Jaundice caused by poor liver function

Jaundice can happen if your baby’s liver doesn’t work well. This may be because of an infection or other factors.  

Who is at risk for hyperbilirubinemia in the newborn?

About 6 in 10 full-term newborns get jaundice. So do 8 in 10 premature babies. Babies born to mothers with diabetes or Rh disease are more likely to have this condition.

What are the symptoms of hyperbilirubinemia in the newborn?

Symptoms can occur a bit differently in each child. They can include:

  • Yellowing of your baby’s skin and the whites of his or her eyes. This often starts on a baby’s face and moves down his or her body.
  • Poor feeding
  • Lack of energy

The symptoms of this health problem may be similar to symptoms of other conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is hyperbilirubinemia in the newborn diagnosed?

The timing of when your child’s jaundice first starts matters. It may help his or her healthcare provider make a diagnosis.

  • First 24 hours. This type of jaundice is often serious. Your child will likely need treatment right away.
  • Second or third day. This is often physiologic jaundice. Sometimes it can be a more serious type of jaundice.
  • Toward the end of the first week. This type of jaundice may be from an infection.
  • In the second week. This is often caused by breastmilk jaundice.

Your child’s doctor may do the following tests to confirm the diagnosis:

  • Direct and indirect bilirubin levels. These levels show if bilirubin is bound with other substances by your child’s liver. If so, it can be eliminated from your child’s body (direct). Or this test may show that the bilirubin is circulating in your child’s blood (indirect).
  • Red blood cell counts
  • Blood type and testing for Rh incompatibility (Coomb's test)

How is hyperbilirubinemia in the newborn treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Phototherapy

Bilirubin absorbs light. High bilirubin levels often decrease when a baby is put under special blue spectrum lights. This is called phototherapy. Your child may get this treatment in the day and night. It may take several hours for it to start working.  During light treatment, your baby’s eye will be protected. Your baby’s healthcare provider will check your baby’s temperature. He or she will also test your baby’s bilirubin levels. This will tell if phototherapy is working.

Fiber optic blanket

A fiber optic blanket is another form of phototherapy. The blanket it put under your baby. It may be used alone or with regular phototherapy.

Exchange transfusion

This test removes your baby’s blood that has a high bilirubin level. It replaces it with fresh blood that has a normal bilirubin level. This raises your baby’s red blood cell count. It also lowers his or her bilirubin level. In this test, your baby will alternate giving and getting small amounts of blood. This will be done through a vein or artery. Your baby may need to have this procedure again if his or her bilirubin levels stay high.

Hydration with breastmilk

The American Academy of Pediatrics says that you should keep breastfeeding a baby with jaundice. If your baby is dehydrated from light therapy, you may need to supplement with pumped breastmilk or formula. You may also need to do this if your baby has lost too much weight.

Treating any underlying cause of the condition

This may include treating an infection.

What are the complications of hyperbilirubinemia in the newborn?

High levels of bilirubin can travel to your baby’s brain. This can cause seizures and brain damage. This is called kernicterus.

Can hyperbilirubinemia in the newborn be prevented?

This condition cannot really be prevented. Spotting jaundice early and getting treatment right away are key. This can stop your baby’s bilirubin levels from rising to dangerous levels.

Key points about hyperbilirubinemia in the newborn

  • Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.
  • About 6 in 10 full-term newborns and 8 in 10 premature babies get jaundice.
  • The most common symptom is yellowing of your baby’s skin and the whites of his or her eyes.
  • The timing of when your child’s jaundice first starts matters. It can help his or her healthcare provider make a diagnosis.
  • Spotting jaundice early and getting treatment right away are key. This can stop your child’s bilirubin from rising to dangerous levels.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.