Bilirubin Level in Newborn Baby

Introduction

Bilirubin is a vital product formed when red blood cells break down. It adds yellow pigment to bile, stool, and a small amount of urine. Although this bilirubin is beneficial, excess bilirubin can be harmful. Thankfully, our body has effective mechanisms to safely process and eliminate it. The liver plays a key role by converting bilirubin into a form that can be excreted or eliminated through the stool. This natural detoxification process ensures that bilirubin levels remain balanced, promoting overall well-being. Bilirubin levels in newborns are a critical aspect of their health that parents should be aware of. By gaining a better understanding of bilirubin levels in newborns, parents can be equipped to ensure the optimal health of their little ones.¹ 

Importance of Bilirubin

Bilirubin is a substance of significant importance in our bodies. It is a byproduct formed during the breakdown of red blood cells and other heme-containing proteins. Here are some key reasons why bilirubin is important:

• Bile Component: Bilirubin is a crucial component of bile, which is produced by the liver to aid in the digestion of food. Bile helps break down fats and facilitates their absorption in the intestines.

• Waste Elimination: Bilirubin serves as a significant example of waste elimination through bile. It is a byproduct of red blood cell breakdown and is excreted from the body through bile. This process helps eliminate waste substances from the body.

• Detoxification: The mechanisms involved in bilirubin clearance are like those used in the elimination of many medications and toxic substances. This highlights the importance of bilirubin in detoxifying the body and maintaining overall health.

• Antioxidant Properties: Bilirubin has antioxidant properties, which means it helps protect our cells from damage caused by harmful free radicals. It acts as a natural protection mechanism against oxidative stress and inflammation.

• Diagnostic Marker: Elevated levels of bilirubin in the blood, a condition known as jaundice, can indicate underlying health issues such as liver dysfunction, gallstones, or certain blood disorders. Monitoring bilirubin levels is important in diagnosing and managing these conditions. In newborns, monitoring bilirubin levels is crucial. Elevated bilirubin levels can lead to neonatal jaundice, a common condition in newborns. Timely detection and appropriate management of bilirubin levels are essential to prevent complications and ensure the well-being of the baby.

Understanding the importance of bilirubin helps us appreciate its role in digestion, waste elimination, cellular protection, and as a diagnostic marker. Proper management of bilirubin levels is crucial for maintaining overall health and identifying potential health issues.^2-5

What is the Normal Level of Bilirubin in Newborn Baby

• According to the recommendations of the American Academy of Pediatrics (AAP), bilirubin levels up to 17-18 mg/dl can be considered within the normal range for healthy full-term newborns.
• Newborns have a higher production rate of bilirubin compared to adults, generating around 6 to 8 mg per kg per day. 

It’s important for healthcare professionals to monitor bilirubin levels in newborns to ensure they remain within the appropriate range for optimal health.^6,7

Why Newborns Are Susceptible to High Bilirubin Levels

Newborns are susceptible to high bilirubin levels due to the following reasons:

• Increased Red Blood Cell Breakdown: Newborn babies have a higher number of red blood cells in their blood compared to adults. These red blood cells are broken down and replaced more frequently, resulting in higher production of bilirubin.
• Immature Liver Function: The liver of a newborn baby is not fully developed and is less efficient at processing bilirubin and eliminating it from the blood. This leads to a slower rate of bilirubin clearance from the body.
• Elevated Bilirubin Levels: As a result of increased red blood cell breakdown and immature liver function, the level of bilirubin in newborns is significantly higher than in adults.
• Developmental Changes: As the baby grows and reaches around 2 weeks of age, their bilirubin production decreases, and the liver becomes more effective at processing and eliminating bilirubin from the body.

It is important to note that proper monitoring and management of bilirubin levels in newborns is essential to ensure their well-being.^7,8

How High Levels of Bilirubin Can Affect Newborns

High levels of bilirubin in newborns may have harmful effects, like:

• Excessive bilirubin in a baby’s blood may affect the baby’s brain cells.
• The baby may become less active as a result of elevated bilirubin levels.
• In rare cases, seizures (convulsions) might occur.

Severely high levels of bilirubin may lead to complications such as:

• Hearing impairment 
• Cerebral palsy 
• Intellectual disability

Fortunately, these complications can usually be prevented with proper monitoring and intervention.⁹

Symptoms of High Bilirubin Levels in Newborns

Signs of high bilirubin Levels:

• Jaundice: Yellowing of the skin, starting from the face and spreading to the chest, stomach, arms, and legs.
• Skin Colour Test: Pressing a finger on the baby’s forehead or nose and observing a yellow appearance when the finger is removed.

Signs of Worsening Jaundice (requiring immediate medical attention):

• Darker Yellow Colour: The yellow colour becomes darker in appearance, changing from a lemon yellow to an orange-yellow shade.
• Yellowing of the “Whites” of the Eyes.
• Visible Below the Knees: The yellow colour extends below the knees, beyond the areas previously affected.
• Fever
• Difficulty Eating: The baby experiences difficulties while feeding.
• Increased sleepiness
• Difficult to wake up.
• Irritability and Difficulty Consoling: The baby becomes irritable and is difficult to soothe.
• Arching of the Neck or Body.

If you observe any of these signs, especially those indicating worsening jaundice, it is crucial to seek immediate medical attention from a healthcare professional to ensure appropriate evaluation and management.¹⁰

Diagnosis and Treatment of High Bilirubin Levels in Newborns

Diagnosis of High Bilirubin Levels in Newborns

• Newborn Physical Examination: Within 72 hours of birth, a visual examination checks for jaundice signs, such as yellowing of the skin, whites of the eyes, gums, and urine/stool colour.
• Home Observation: Parents should monitor for yellowing skin/eyes, use gentle pressure to check for yellow appearance, and observe urine (should be colourless) and stool (should be yellow/orange).
• Consultation: Promptly contact a healthcare provider if jaundice is suspected.
• Visual Examination: A thorough assessment is conducted in good light to evaluate jaundice extent, including skin, eyes, gums, and urine/stool colour.
• Bilirubin Test: A bilirubin level test is performed using a bilirubinometer (light reflection/absorption) or a blood sample (serum bilirubin measurement).
• Further Tests: If necessary, additional blood tests may be conducted to assess blood group compatibility, presence of antibodies, red blood cell count, infection markers, and enzyme deficiencies.

Based on the test results and evaluations, the healthcare provider determines the need for treatment. It is essential to follow medical advice and guidance when managing high bilirubin levels in newborns.¹¹

Treatment of High Bilirubin Levels in Newborns

• Frequent Feeding: Adequate breastfeeding helps eliminate bilirubin through stools and urine.
• Phototherapy: This common treatment involves exposing the baby’s skin to special blue light, which breaks down bilirubin for elimination. It is safe and effective, with close monitoring of the baby’s skin colour, temperature, and diaper output.
• Sunlight Exposure: Not recommended due to the risk of sunburn.
• Discontinuation of Phototherapy: Treatment is stopped when bilirubin levels reach a safe level, although mild jaundice may persist temporarily.
• Side Effects: Temporary side effects may include skin rashes and loose stools. Monitoring the baby’s skin colour, temperature, and diaper output is important.
• Bronze Baby Syndrome: Some babies may develop temporary skin and urine discolouration, which may gradually resolve without treatment.
• Breastfeeding During Phototherapy: Breast milk is encouraged, as bilirubin is excreted in urine and stool. Oral glucose water is not necessary, but babies with severe dehydration may require IV fluids.
• Supplemental Feeding: If breastfeeding alone is insufficient, temporary supplementation with expressed breast milk or formula may be needed.
• Exchange Transfusion: An emergency procedure involving blood replacement from a donor, exchange transfusion rapidly lowers bilirubin levels in severe cases. It is reserved for babies at risk of brain damage.

It is essential to consult healthcare professionals to determine the appropriate treatment for high bilirubin levels in newborns.¹⁰

Prevention and Management of High Bilirubin Levels in Newborns

Prevention of High Bilirubin Levels in Newborns

• Screening: It is recommended that all newborns undergo bilirubin-level testing before leaving the hospital, regardless of age. Repeated testing is necessary if jaundice is present within the first day of life.
• Monitoring: Parents, caregivers, and healthcare providers should keep a watchful eye on babies for signs of jaundice. Prompt action is crucial to prevent complications. If concerned about worsening jaundice, contact the baby’s healthcare provider immediately.
• Prompt Treatment: Babies with high bilirubin levels should receive timely treatment from qualified healthcare providers to reduce bilirubin levels and prevent the risk of brain damage. Treatment should never be put off for any reason.

Regular follow-up visits with the doctor are important for babies at risk of hyperbilirubinemia. By implementing these preventive measures, serious complications associated with high bilirubin levels can be avoided.¹⁰

Management of High Bilirubin Levels in Newborns

• Aggressive treatment guidelines for hyperbilirubinemia were based on infants with hemolysis (breakdown of red blood cells) and total bilirubin levels above 20 mg/dL. However, recent research shows that healthy term infants without hemolysis can tolerate higher levels.
• Initial treatment focuses on phototherapy rather than exchange transfusion.
• The American Academy of Pediatrics provides guidelines for managing hyperbilirubinemia (high bilirubin levels) in healthy-term newborns. Jaundice in newborns less than 24 hours old is always considered abnormal and requires investigation and treatment. The risk of significant hyperbilirubinemia is categorized as low, intermediate, or high based on the rate of bilirubin level rise. Conjugated hyperbilirubinemia is never normal and requires further evaluation.
• If jaundice persists for more than two weeks in formula-fed infants or more than three weeks in breastfed infants, additional tests are necessary, including bilirubin fractionation, thyroid studies, and assessments for metabolic disorders, hemolytic disease, and intestinal obstruction.

By following these management strategies, healthcare providers can effectively address high bilirubin levels in newborns and mitigate potential complications.⁷

Conclusion

In conclusion, monitoring and timely management of bilirubin levels in newborn babies are crucial to prevent complications. Regular check-ups, prompt treatment when needed, and adherence to medical guidelines ensure the well-being and healthy development of infants.

Frequently Asked Questions (FAQs):

References

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2. Direct bilirubin [Internet]. [cited 2023 May 18]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=bilirubin_direct 
3. Biliary Excretion of Waste Products: Elimination of Bilirubin [Internet]. [cited 2023 May 18]. Available from: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bilirubin.html 
4. Adin CA. Bilirubin as a therapeutic molecule: Challenges and opportunities. Antioxidants. 2021;10(10):1536. doi:10.3390/antiox10101536. Available from: https://www.mdpi.com/2076-3921/10/10/1536 
5. Bilirubin blood test: Medlineplus medical test [Internet]. U.S. National Library of Medicine; [cited 2023 May 18]. Available from: https://medlineplus.gov/lab-tests/bilirubin-blood-test/
6. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iranian journal of public health. 2016 May;45(5):558. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935699/ 
7. Porter ML, Dennis BL. Hyperbilirubinemia in the term newborn [Internet]. 2002 [cited 2023 May 18]. Available from: https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html 
8. Causes -Newborn jaundice [Internet]. NHS; [cited 2023 May 18]. Available from: https://www.nhs.uk/conditions/jaundice-newborn/causes/#:~ 
9. Jaundice in newborns. Paediatrics & Child Health. 2007;12(5):409–10. doi:10.1093/pch/12.5.409. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528723/ 
10. Wong RJ, Bhutani VK. Jaundice in newborn infants (Beyond the Basics) [Internet]. 2022 [cited 2023 May 18]. Available from: https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics/print 
11. Diagnosis -Newborn jaundice [Internet]. NHS; [cited 2023 May 18]. Available from: https://www.nhs.uk/conditions/jaundice-newborn/diagnosis/  

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