Hyperbilirubinemia and Jaundice
What is hyperbilirubinemia?Hyperbilirubinemia is a condition in which there is too much
bilirubin in the blood. When red blood cells break down, a substance
called bilirubin is formed. Babies are not easily able to get rid of the
bilirubin and it can build up in the blood and other tissues and fluids of
the baby's body. This is called hyperbilirubinemia. Because bilirubin has
a pigment or coloring, it causes a yellowing of the baby's skin and
tissues. This is called jaundice.
Depending on the cause of the hyperbilirubinemia, jaundice may appear
at birth or at any time afterward.
What causes hyperbilirubinemia? During pregnancy, the placenta excretes bilirubin. When the
baby is born, the baby's liver must take over this function. There are
several causes of hyperbilirubinemia and jaundice, including the
following:
- physiologic jaundice
Physiologic jaundice occurs as a "normal" response to the baby's limited
ability to excrete bilirubin in the first days of life.
- breast milk jaundice
About 2 percent of breastfed babies develop jaundice after the first
week. Some develop breast milk jaundice in the first week due to low
calorie intake or dehydration.
- jaundice from hemolysis
Jaundice may occur with the breakdown of red blood cells due to
hemolytic disease of the newborn (Rh disease), having too many red blood
cells, or bleeding.
- jaundice related to inadequate liver function
Jaundice may be related to inadequate liver function due to infection or
other factors.
Who is affected by hyperbilirubinemia? About 60 percent of term newborns and 80 percent of premature
babies develop jaundice. Infants of diabetic mothers and of mothers with
Rh disease are more likely to develop hyperbilirubinemia and jaundice.
Why is hyperbilirubinemia a concern? Although low levels of bilirubin are not usually a concern,
large amounts can circulate to tissues in the brain and may cause seizures
and brain damage. This is a condition called kernicterus.
What are the symptoms of hyperbilirubinemia? The following are the most common symptoms of
hyperbilirubinemia. However, each baby may experience symptoms
differently. Symptoms may include:
- yellow coloring of the baby's skin (usually beginning on the face
and moving down the body)
- poor feeding or lethargy
The symptoms of hyperbilirubinemia may resemble other conditions or
medical problems. Always consult your baby's physician for a diagnosis.
How is hyperbilirubinemia diagnosed?
The timing of the appearance of jaundice helps with the diagnosis.
Jaundice appearing in the first 24 hours is quite serious and usually
requires immediate treatment. When jaundice appears on the second or third
day, it is usually "physiologic." However, it can be a more serious type
of jaundice. When jaundice appears on the third day to the first week, it
may be due to an infection. Later appearance of jaundice, in the second
week, is often related to breast milk feedings, but may have other causes.
Diagnostic procedures for hyperbilirubinemia may include:
- direct and indirect bilirubin levels
These reflect whether the bilirubin is bound with other substances by
the liver so that it can be excreted (direct), or is circulating in the
blood circulation (indirect).
- red blood cell counts
- blood type and testing for Rh incompatibility (Coomb's test)
Treatment for hyperbilirubinemia:Specific treatment for hyperbilirubinemia will be determined by
your baby's physician based on:
- your baby's gestational age, overall health, and medical history
- extent of the disease
- your baby's tolerance for specific medications, procedures, or
therapies
- expectations for the course of the disease
- your opinion or preference
Treatment depends on many factors, including the cause of the
hyperbilirubinemia and the level of bilirubin. The goal is to keep the
level of bilirubin from increasing to dangerous levels. Treatment may
include:
- phototherapy
Since bilirubin absorbs light, jaundice and increased bilirubin levels
usually decrease when the baby is exposed to special blue spectrum
lights. Phototherapy may take several hours to begin working and it is
used throughout the day and night. The baby's position is changed to
allow all of the skin to be exposed to the light. The baby's eyes must
be protected and the temperature monitored during phototherapy. Blood
levels of bilirubin are checked to monitor if the phototherapy is
working.
- fiberoptic blanket
Another form of phototherapy is a fiberoptic blanket placed under the
baby. This may be used alone or in combination with regular
phototherapy.
- exchange transfusion to replace the baby's damaged blood with
fresh blood
Exchange transfusion helps increase the red blood cell count and lower
the levels of bilirubin. An exchange transfusion is done by alternating
giving and withdrawing blood in small amounts through a vein or artery.
Exchange transfusions may need to be repeated if the bilirubin levels
remain high.
- ceasing breastfeeding for one or two days
Treatment of breast milk jaundice often requires stopping the
breastfeeding for one to two days and giving the baby formula often
helps lower the bilirubin levels. Breastfeeding can then be resumed.
- treating any underlying cause of hyperbilirubinemia, such as
infection
Prevention of hyperbilirubinemia:While hyperbilirubinemia cannot be totally prevented, early
recognition and treatment are important in preventing bilirubin levels
from rising to dangerous levels.
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