Jaundice is a common and easily diagnosed condition in newborns caused by elevated bilirubin levels. If jaundice is not properly handled, it then leads to kernicterus, a dangerous and permanent form of brain damage. Doctors can conduct diagnostic testing to determine a child’s bilirubin levels and take appropriate action depending on when jaundice first appears. They can treat jaundice using phototherapy, blood transfusions or by treating any underlying causes such as infections. Because jaundice is so easily diagnosed and treated, kernicterus is highly preventable.
Bilirubin is a by-product of red blood cells being broken down in the body. Infants are not able to easily get rid of the bilirubin and so it often builds up in the baby’s blood and tissues. This is called hyperbilirubinemia. Because bilirubin has a pigment, it causes yellowing of the skin and white parts of the eyes, which is called jaundice. About 60% of full-term infants and 80% of preterm infants will develop jaundice as a result of elevated bilirubin.
Elevated Bilirubin, Jaundice and Kernicterus*
Medical Explanations
Symptoms of Elevated Bilirubin
Every baby is different and therefore may experience different symptoms at different times. However, the following are the most common hyperbilirubinemia symptoms:
- Jaundice, yellowing of the baby’s skin (usually starting on the face and moving down the body)
- poor feeding
- lethargy, tiredness
Diagnosis of Elevated Bilirubin
There are several diagnostic tests that can be done to confirm hyperbilirubinemia. These include:
- direct and indirect tests of bilirubin levels, checking whether the liver is passing the bilirubin so it can be excreted (direct) or is if it’s being circulated in the blood (indirect).
- red blood cell counts
- blood type and testing for Rh incompatibility (Coomb’s test)
The timing of the first appearance of jaundice helps with diagnosis and treatment. If jaundice appears within the first 24 hours, it is serious and should be treated immediately. If the jaundice appears on the second or third day after birth, it is usually “physiological jaundice,” which is the common jaundice seen in the majority of infants and is not serious. When jaundice appears on the third day to the first week, it may be from an infection. Later appearance of jaundice, is often related to breast milk feedings, but may have other causes.
Treatment of Elevated Bilirubin
Treatment depends on many factors, including the cause of the hyperbilirubinemia and the actual level of bilirubin. Some common treatments:
- Phototherapy. The baby is exposed to a special blue-spectrum light that decreases the bilirubin levels. Blood tests are performed afterwards to check bilirubin levels to ensure the phototherapy is working.
- Fiber optic blanket. This is another form of phototherapy. The blanket is placed underneath the infant and can be used alone or along with regular phototherapy.
- Blood transfusion to increase the red blood cell count and reduce the levels of bilirubin.
- Treatment of any underlying causes of hyperbilirubinemia, such as infection.
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