High bilirubin levels in infants, known as hyperbilirubinemia, are common, particularly in newborns. Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. The liver processes bilirubin, which is then excreted through bile and urine. In infants, especially newborns, the liver might not be mature enough to process bilirubin effectively, leading to its accumulation in the blood, causing jaundice.
Causes of High Bilirubin in Infants
Physiological Jaundice: This is the most common type of jaundice in newborns and typically appears on the second or third day of life. It results from the natural breakdown of fetal hemoglobin as the newborn’s body switches to producing adult hemoglobin.
Breastfeeding Jaundice: Poor feeding or dehydration can lead to breastfeeding jaundice. Ensuring proper breastfeeding techniques and frequency can mitigate this type of jaundice.
Breast Milk Jaundice: Some substances in breast milk can interfere with the liver’s ability to process bilirubin. This type of jaundice usually peaks during the second or third week of life.
Blood Group Incompatibility: If the mother and baby have different blood types, the mother’s antibodies might attack the baby’s red blood cells, leading to increased bilirubin production.
Other Medical Conditions: Conditions such as hemolytic anemia, infections, or enzyme deficiencies can contribute to high bilirubin levels.
Symptoms of High Bilirubin in Infants
Yellowing of the Skin and Eyes:
The primary symptom is a yellowish tint to the skin and the whites of the eyes, starting on the face and spreading to the chest, belly, arms, and legs.
Poor Feeding:
Infants with high bilirubin levels may have difficulty feeding, leading to less frequent or shorter feeding sessions.
Lethargy:
Affected infants may appear more tired or less responsive than usual.
Dark Urine:
The urine of a newborn with high bilirubin might be darker than usual.
Pale Stools:
Infants might produce pale-colored stools, which is a sign that bilirubin is not being processed properly by the liver.
SEE ALSO: When Should a Newborn See a Pediatrician?
Diagnosing High Bilirubin in Infants
Visual Examination:
The initial diagnosis is often made through a visual examination, where the doctor looks for signs of jaundice in the baby’s skin and eyes.
Bilirubin Test:
Blood tests measure the level of bilirubin in the baby’s blood. This test helps determine the severity of jaundice and the need for treatment.
Other Tests:
In some cases, additional tests might be necessary to identify the underlying cause of high bilirubin levels, such as blood type tests, Coombs test, or tests for enzyme deficiencies.
Treatment Options for High Bilirubin in Infants
Phototherapy
How Phototherapy Works: Phototherapy is the most common treatment for high bilirubin levels in infants. The baby is placed under special blue lights that help break down bilirubin in the skin. The bilirubin is then more easily excreted in the baby’s urine and stool.
Types of Phototherapy:
Conventional Phototherapy: The baby lies under a bank of lights, usually wearing only a diaper and protective eye covers.
Fiberoptic Phototherapy: The baby lies on a special blanket that emits light, which can be wrapped around the baby or placed underneath.
Duration of Treatment: Phototherapy typically continues for several hours to several days, depending on the bilirubin levels and the baby’s response to the treatment. Bilirubin levels are monitored frequently during this period.
Exchange Transfusion
When Exchange Transfusion is Needed: Exchange transfusion is used for severe cases of hyperbilirubinemia that do not respond to phototherapy. It involves gradually removing the baby’s blood and replacing it with donor blood. This procedure reduces the bilirubin levels quickly and also removes antibodies that might be contributing to the breakdown of red blood cells.
Procedure Details: The procedure is usually performed in a neonatal intensive care unit (NICU) under sterile conditions. The baby’s blood is removed in small amounts and replaced with matched donor blood, helping to lower bilirubin levels and improve the baby’s condition.
Intravenous Immunoglobulin (IVIg) Therapy
Purpose of IVIg Therapy: IVIg therapy is used when hyperbilirubinemia is caused by blood group incompatibility. It helps reduce the levels of antibodies that are attacking the baby’s red blood cells.
How IVIg Works: IVIg is administered through an intravenous (IV) line, and it works by blocking the antibodies responsible for breaking down red blood cells. This helps reduce the production of bilirubin.
Enhanced Feeding
Increasing Feeding Frequency: Ensuring the baby feeds frequently can help lower bilirubin levels. Feeding stimulates bowel movements, which helps excrete bilirubin from the body.
Breastfeeding Support: Lactation consultants can provide support and guidance to mothers to ensure proper breastfeeding techniques and adequate milk intake. In some cases, supplementing with formula may be recommended if the baby is not getting enough breast milk.
Monitoring and Follow-Up
Frequent Bilirubin Checks: After treatment, frequent bilirubin level checks are necessary to ensure they do not rise again. This can be done through blood tests or transcutaneous bilirubin meters.
Regular Pediatric Visits: Regular visits to the pediatrician help monitor the baby’s overall health and development. The doctor will check for any signs of recurring jaundice or other related issues.
Preventing High Bilirubin in Infants
Proper Feeding:
Ensuring the baby is feeding well, whether through breastfeeding or formula, can help prevent high bilirubin levels. Frequent feeding helps promote regular bowel movements, which aid in bilirubin excretion.
Monitoring High-Risk Infants:
Babies who are at a higher risk of developing jaundice, such as those with blood type incompatibility or premature infants, should be closely monitored for signs of jaundice.
Early Detection:
Early detection and treatment of high bilirubin levels can prevent complications. Parents should be educated on the signs of jaundice and when to seek medical attention.
Conclusion
High bilirubin levels in infants are common but can be effectively treated with proper medical intervention. Phototherapy remains the cornerstone of treatment, while exchange transfusion, IVIg therapy, and enhanced feeding strategies are used in more severe cases. Regular monitoring and early detection are crucial in managing hyperbilirubinemia and preventing complications. By understanding the causes, symptoms, and treatment options, parents and healthcare providers can work together to ensure the best outcomes for infants with high bilirubin levels.
