Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks down heme in red blood cells. This process is crucial because it helps the body get rid of old red blood cells, making way for new ones. In newborns, especially those who are only a few days old, bilirubin levels can sometimes become elevated, leading to a condition known as hyperbilirubinemia.
Types of Jaundice in Newborns
There are two main types of jaundice in newborns: physiological jaundice and pathological jaundice.
Physiological Jaundice
Physiological jaundice is the most common type. It usually appears within the first few days of life and typically resolves without treatment. It occurs because newborns have a high turnover of red blood cells, and their liver is still maturing and learning to process bilirubin effectively.
Pathological Jaundice
Pathological jaundice, on the other hand, is more serious. It can appear within the first 24 hours after birth and requires immediate medical attention. It can be caused by several factors, including blood group incompatibility, infections, and genetic conditions.
Measuring Bilirubin Levels
Bilirubin levels are measured using a blood test. The results are typically expressed in milligrams per deciliter (mg/dL). The American Academy of Pediatrics (AAP) provides guidelines on what bilirubin levels are considered safe and what levels require treatment.
Safe Bilirubin Levels
For most newborns, a bilirubin level of less than 12 mg/dL is considered safe. However, what is considered safe can vary depending on the baby’s age in hours, gestational age, and overall health.
High Bilirubin Levels
Levels above 12 mg/dL may require further monitoring and possible treatment.
Dangerous Bilirubin Levels
Identifying Dangerous Levels
Dangerous bilirubin levels in newborns are those that are high enough to potentially cause a condition called kernicterus, which can lead to permanent brain damage. According to the AAP, bilirubin levels of 25 mg/dL or higher are considered dangerous and require immediate medical intervention.
Risk Factors for High Bilirubin Levels
Several factors can increase the risk of a newborn developing high bilirubin levels:
Prematurity: Premature babies are at higher risk because their livers are even less mature than those of full-term babies.
Bruising During Birth: Babies who experience bruising during birth have more red blood cells that need to be broken down, leading to higher bilirubin levels.
Blood Type Incompatibility: When the mother and baby have incompatible blood types, the mother’s antibodies can attack the baby’s red blood cells, increasing bilirubin levels.
Breastfeeding Issues: Babies who have trouble breastfeeding and are not getting enough milk can become dehydrated, which can increase bilirubin levels.
Genetic Factors: Certain genetic conditions can affect how the body processes bilirubin.
SEE ALSO: What Level Bilirubin Is Jaundice in Newborns
Symptoms of High Bilirubin Levels
It is crucial to monitor newborns for symptoms of high bilirubin levels. Some common symptoms include:
Yellowing of the Skin and Eyes:
This is the most obvious symptom and usually starts at the head and spreads downwards.
Poor Feeding:
Babies with high bilirubin levels may have difficulty feeding.
Lethargy:
Excessive sleepiness or difficulty waking up can be a sign of high bilirubin levels.
High-Pitched Crying:
A high-pitched cry can indicate severe jaundice and the need for immediate medical attention.
Arching of the Body:
This can be a sign of severe bilirubin toxicity and requires urgent care.
Diagnosis and Monitoring
To diagnose high bilirubin levels, doctors will typically perform a physical examination and order a blood test. The blood test will measure the total serum bilirubin (TSB) level.
Transcutaneous Bilirubinometry
In some cases, a non-invasive test called transcutaneous bilirubinometry may be used. This device measures bilirubin levels through the skin and can help determine if a blood test is necessary.
Bilirubin Nomogram
The results of the blood test are then compared to a bilirubin nomogram, which helps determine the risk level and the need for treatment. The nomogram takes into account the baby’s age in hours and the measured bilirubin level.
Treatment Options
Phototherapy
The most common treatment for high bilirubin levels is phototherapy. During phototherapy, the baby is placed under special lights that help break down bilirubin in the skin. This treatment is safe and effective and usually requires a hospital stay.
Exchange Transfusion
In severe cases, where phototherapy is not enough, an exchange transfusion may be necessary. This procedure involves removing small amounts of the baby’s blood and replacing it with donor blood. This helps reduce the bilirubin level quickly.
Intravenous Immunoglobulin (IVIg)
For babies with blood type incompatibility, intravenous immunoglobulin (IVIg) may be used. This treatment helps reduce the levels of antibodies that are attacking the baby’s red blood cells, thereby lowering bilirubin levels.
Preventing High Bilirubin Levels
Early Feeding
One of the best ways to prevent high bilirubin levels is to ensure that the baby is feeding well. Frequent feeding helps the baby pass stools, which helps eliminate bilirubin from the body.
Monitoring
Babies at risk of developing high bilirubin levels should be closely monitored in the first few days of life. This includes regular checks of their bilirubin levels and overall health.
Identifying Risk Factors
Parents and healthcare providers should be aware of the risk factors for high bilirubin levels. This can help ensure that babies who are at risk receive the necessary monitoring and treatment.
Long-Term Effects of High Bilirubin Levels
If left untreated, high bilirubin levels can lead to kernicterus, a type of brain damage that can cause permanent neurological problems. Some long-term effects of kernicterus include:
Cerebral Palsy: This is a group of disorders that affect movement and muscle tone.
Hearing Loss: High bilirubin levels can damage the parts of the brain responsible for hearing.
Vision Problems: Kernicterus can affect the parts of the brain that control vision.
Intellectual Disabilities: Severe jaundice can lead to developmental delays and intellectual disabilities.
Conclusion
Understanding what constitutes a dangerous bilirubin level in newborns is crucial for parents and healthcare providers. By recognizing the risk factors, symptoms, and treatment options, it is possible to prevent the severe consequences of high bilirubin levels. Early detection and prompt treatment are key to ensuring the health and well-being of newborns. If you suspect your baby may have high bilirubin levels, seek medical attention immediately to prevent potential complications.
