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Rebecca Heckaman

Jackson College


What is hyperbilirubinemia? Hyperbilirubinemia is the excess of bilirubin in the blood.

Bilirubin is a reddish-yellow, water insoluble pigment, that is formed by the breakdown of heme

(Bilirubin). The liver is what filters bilirubin from the bloodstream. It is then released into the

intestinal tract. In a newborn the immature liver often struggles to remove bilirubin as quick as

needed, from there the excess bilirubin stays in the blood, and can enter tissues, and other fluids

(Diseases and Conditions). Excess bilirubin being in the infant’s tissues can show as jaundice of

the skin or eyes.

There are several signs and symptoms that should be looked for to detect

hyperbilirubinemia. The most notable sign is an infant’s body or whites of the eyes appearing

yellow or jaundice, especially if it lasts longer than 3 weeks. Bilirubin levels become elevated in

the blood of almost all infants in the first few days after birth, while jaundice takes place in more

than half of them (Porter & Dennis). For most of the infants, jaundice and elevation represents a

normal and routine physiological phenomenon and as such does not cause any specific problem.

Some other signs are infants seeming listless or sick of hyperbilirubinemia (Hyperbilirubinemia

and Jaundice). Some or all signs and symptoms may be present when an infant has

hyperbilirubinemia, but it is important to notice any or all changes in an infant.

Bilirubin in low levels is not usually a concern. When test show large amounts of

bilirubin circulating tissues in the brain it may cause seizures or brain damage because it is toxic

to brain tissue. Acute bilirubin encephalopathy may occur if severe jaundice is present and

bilirubin passes into the brain. Receiving treatment quickly may prevent permanent damage. If

permanent damage does occur, it results in the condition called kernicterus (Hyperbilirubinemia

and Jaundice). It is important to see the signs of hyperbilirubinemia in the infant early and seek

treatment for it.

Like treatments for all diseases the overall health of the infant, the extent of the

hyperbilirubinemia, and the expectation for the outcome all factor into the decision of how it

should be treated. The treatment options for hyperbilirubinemia include phototherapy, fiber optic

blanket, or exchange transfusion. Sometimes an underlying infection may cause the

hyperbilirubinemia and managing the infection can cure it. Phototherapy is used because

bilirubin absorbs light; bilirubin levels usually decrease when the infant is exposed to special

blue spectrum lights. It may take several hours to begin working and it is used throughout the

day and night. The baby’s eyes must be protected and the temperature needs to be monitored

during phototherapy. Blood levels of bilirubin are checked throughout treatment to monitor if it

is working. Another form of phototherapy is a fiber optic blanket placed under the infant. Fiber

optic blankets may be used alone or in combination with regular phototherapy (Porter & Dennis).

It is also recommended that breastfeeding be continued throughout phototherapy because it can

help with dehydration and weight loss. Another treatment is exchange fusion. This is the use of a

blood transfusion. This process involves repeatedly withdrawing small amounts of blood,

diluting the bilirubin and maternal antibodies, and then transferring blood back into the infant.

Exchange fusion is usually only used when other treatments do not work (Diseases and

Conditions Infant Jaundice). The early recognition and treatment of hyperbilirubinemia are the

most important in preventing bilirubin levels from rising to dangerous levels.


Bilirubin. (n.d.) Retrieved September 18, 2016, from http://www.merriam-

Diseases and Conditions Infant Jaundice. (n.d.) Retrieved September 18, 2016, from


Hyperbilirubinemia and Jaundice. (n.d.) Retrieved September 18, 2016, from


Porter, Meredith L., CPT, MC, USA, and Beth L. Dennis, MAJ, MC, USA, Dewitt Army

Community Hospital, Fort Belvoir, Virginia. (n.d.) Hyperbilirubinemia in the Term

Newborn. Retrieved September 18, 2016, from