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Hyperbilirubinemia

R​ed blood cells in the body are constantly breaking down and being replaced with new

red blood cells. During the process of RBC (red blood cells) being broken down a yellow

substance known as bilirubin is formed. In a healthy person the fully matured liver helps to

filter, and dispose of all the unneeded bilirubin as fast as it is being produced. During pregnancy

the placenta helps excrete bilirubin. Once the baby is born, the baby’s liver must assume the

entire functioning role of excretion and often times the bilirubin tends to build up in the blood,

fluids and tissues. This condition is known as hyperbilirubinemia and is very common in

newborn babies. Due to the excessive buildup of bilirubin; a yellow substance, newborns can

acquire yellow skin, and eyes, this is called jaundice.

Jaundice is more common in newborns of diabetic mothers with RH disease, some

mothers who breastfeed, some mothers who fail to breastfeed, babies with possible liver

infections or developmental issues, and premature infants. However about 60% of full term

relatively healthy newborns have also been known to develop jaundice at birth or after birth. The

presence of jaundice in the first 24 hours of birth is less of a concern than jaundice appearing

later; first week or two of birth. Jaundice that presents later can be associated with some forms

of infection and needs to be treated right away. Treatments for jaundice may differ depending

on each baby and each circumstance. According to Stanford Children's Health, Lucile Packard

Children's hospital, Stanford some common treatments are:

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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.

Different techniques may be used 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.

Adequate hydration with breastfeeding or pumped breast milk. ​The American

Academy of Pediatrics recommends that, if possible, breastfeeding be continued. Breastfed

babies receiving phototherapy who are dehydrated or have excessive weight loss can have

supplementation with expressed breast milk or formula.

Treating any underlying cause of hyperbilirubinemia, such as infection

​(Lucile Packard,2016) ​.

As indicated above most of the treatments for this condition are basic and non invasive.

Low levels of bilirubin are not much of a concern, however It is very important to know the signs

and symptoms of this condition because it can progress into a kernicterus state.
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Kernicterus is a condition in which the levels of bilirubin become elevated drastically; large

amounts of built up bilirubin can circulate to the brain tissue and cause seizures and even brain

damaged if not treated appropriately. Signs and symptoms as stated above, are yellowing of an

infant’s skin and eyes, usually beginning in the face and working its way toward extremities, also

lethargy and a disinterest during feeding time is another symptom. The most crucial times are

within the first 24 hours and those infants who show late symptoms a week or so after being

born, these infants will need to be treated immediately. Hyperbilirubinemia is a condition that is

common, unpreventable, but is easily treated as long as people are educated, and recognize

the signs and symptoms before they progress too far.

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Site Sources

Hyperbilirubinemia and Jaundice. (2017). Retrieved March 18, 2017, from

http://www.stanfordchildrens.org/en/topic/default?id=hyperbilirubinemia-and-jaundice-90-P02375
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