Which complication is associated with high bilirubin levels in the newborn

Paediatr Child Health. 2007 May; 12(5): 409–410.

What is jaundice?

Jaundice is very common in newborn babies. It is usually easy to spot because the baby’s skin and whites of the eyes turn a yellow colour. Babies become jaundiced when they have too much bilirubin in their blood.

Bilirubin is a normal pigment made when red blood cells break down in the body. It is usually processed by the liver, recycled and eliminated in the baby’s stool. When a baby has jaundice, it means either his body is making too much bilirubin or the liver is not getting rid of it quickly enough.

Feeding (especially breastfeeding) your baby often in the first hours and days after birth helps reduce the risk of jaundice. Your baby will pass more stool, and the milk gives your baby’s liver the energy it needs to process the bilirubin.

Is jaundice harmful?

Most jaundice is not harmful to your baby. It usually shows up during the baby’s first 3 to 5 days of life. Then it disappears as the baby’s body learns to deal with bilirubin.

In some situations, however, there is so much bilirubin in a baby’s blood that it can be harmful. If the level of bilirubin becomes very high, it may affect some of the baby’s brain cells. This may cause the baby to be less active. In rare cases, a baby may develop seizures (convulsions). The effects of this kind of jaundice may also lead to deafness, cerebral palsy and/or mental retardation. Fortunately, it can usually be prevented.

How do I know whether my baby’s bilirubin levels will become too high?

There is a blood test that can measure the amount of bilirubin in your baby’s body, and help doctors tell whether your baby will eventually need treatment. It can be performed when your baby has the regular blood test to screen for metabolic diseases. Doctors can also use a special device that measures the bilirubin in the skin.

The nurse or doctor can plot your baby’s result on a graph (Figure 1) if they know exactly how many hours old the baby was when the test was performed.

A nurse or doctor can plot your baby’s bilirubin level on this graph. If the test suggests your baby has a higher than average chance of rising to a level that needs treatment, your doctor will arrange a follow-up visit

The information should be given to you when you and your baby leave the hospital. If the test suggests that your baby has a higher than average chance of getting to a level of bilirubin that needs treating, your doctor will arrange a follow-up visit with someone who can examine your baby, and will perform another test if it is needed.

How is jaundice treated?

When a newborn baby shows signs of jaundice, the doctor performs a physical examination and blood tests to help determine the cause and treatment.

One way to reduce bilirubin levels is to expose the baby’s skin to light, a process called phototherapy. The baby’s eyes are protected from the light by eye patches. With phototherapy, the baby may have skin rashes or loose bowel movements. He may need to take in extra fluids (such as more frequent breastfeeding).

Phototherapy is safe, but is only used when needed (usually for 2 to 3 days). In severe cases, the baby may need to be given fluids intravenously (into his veins with a needle) or through a blood transfusion.

When is jaundice more dangerous?

Jaundice can cause problems for some babies, including:

• Preterm babies born before 37 weeks’ gestation;

• Babies who weigh less than 2500 g at birth;

• Babies whose blood group is incompatible with their mothers’ blood group;

• Babies who develop jaundice early in life, especially during the first 24 h;

• Babies whose jaundice has moved into the arms and legs;

• Babies who have an infection;

• Babies who have bruises and a difficult delivery (for example, where forceps have to be used); and

• Babies whose siblings had jaundice at birth and needed treatment.

After I leave the hospital, when should I call my doctor?

Call your doctor if your baby shows any of the following symptoms:

• Refuses breastfeeding or bottle feeding;

• Is sleepy all the time;

• Has lost a significant amount of weight (more than 10% of her weight at birth); or

• Is extremely jaundiced (arms and legs are a yellow or orange colour).

Your doctor will perform a physical examination, often with blood tests, to see how severe your baby’s jaundice is. The doctor can then determine how it should be treated.

For more information

A Canadian Paediatric Society position statement “Guidelines for detection, management and prevention of hyperbiliribinemia in term and late preterm newborn infants (35 or more weeks’ gestation)”, developed by the Fetus and Newborn Committee, is available at www.cps.ca/english/publications/StatementsIndex.htm.

Footnotes

SOURCE: Developed by the Canadian Paediatric Society’s Fetus and Newborn Committee.

This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.

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