Bilirubin Checks For Newborns: Standard Procedure Or Special Test?

Jaundice is a common condition in newborns, characterised by a yellowing of the skin and eyes. It occurs when there is too much bilirubin in the baby's blood, which is created when the body breaks down old red blood cells. While jaundice usually clears up on its own within a couple of weeks, it is important for healthcare providers to check the bilirubin levels in newborns to ensure that it does not reach harmful levels and cause severe jaundice, which can lead to brain damage and other serious health conditions.

Bilirubin levels are checked to diagnose jaundice in newborns

Bilirubin Levels and Jaundice in Newborns

Bilirubin is a yellow substance produced when the body breaks down old red blood cells. Normally, the liver removes bilirubin from the blood, and it passes out of the body in stool. However, newborn babies often have higher levels of bilirubin in their blood, known as hyperbilirubinemia, which can lead to jaundice.

Jaundice in Newborns

Jaundice is a common condition in newborns, affecting up to 60% of full-term babies and 80% of premature babies during their first week of life. It is characterised by a yellow colour in the skin and whites of the eyes. This yellowing typically starts on the face and then moves down the body. In most cases, jaundice is mild and harmless, resolving on its own within one to two weeks.

Causes of Jaundice in Newborns

Jaundice occurs when there is too much bilirubin in the blood. In newborns, this can be due to several factors:

• An immature liver that is not yet fully developed and efficient at removing bilirubin
• A higher number of red blood cells, which break down more quickly, leading to increased bilirubin production
• Dehydration, especially in breastfed babies who are not nursing well or receiving enough breast milk
• Substances in breast milk that affect the breakdown of bilirubin in the liver, known as breast milk jaundice
• Blood type incompatibility between the mother and baby, leading to the mother's antibodies attacking the baby's red blood cells
• Genetic problems that make red blood cells more fragile
• Conditions affecting the liver or bile system, such as infections, cystic fibrosis, or hepatitis

Diagnosis of Jaundice

Healthcare providers routinely check newborns for jaundice before they leave the hospital, as it is essential to monitor bilirubin levels. This is typically done through a blood test, although sometimes a light machine or probe is used to measure bilirubin in the skin. If the levels are high, a blood test is required to confirm the results.

Treatment of Jaundice

Most cases of jaundice in newborns do not require treatment, as it often resolves on its own. However, in some cases, treatment may be necessary, such as:

• Phototherapy: Special blue lights are used to help break down bilirubin in the skin. The infant is placed under these lights with only a diaper and eye protection.
• Exchange transfusion: In rare and severe cases, a baby's blood may need to be replaced with fresh, donated blood to quickly lower bilirubin levels.
• Intravenous immunoglobulin (IVIg): For babies with blood type incompatibilities, this treatment is given through an IV to block antibodies that attack red blood cells.
• Fluids: Ensuring adequate fluid intake helps to prevent dehydration and lower bilirubin levels.

Jaundice is caused by a buildup of bilirubin in a newborn's blood

Jaundice is a common condition in newborns, characterised by a yellow discolouration of the skin and eyes. It is caused by a buildup of bilirubin in the blood, which occurs when the liver is unable to remove it effectively. Bilirubin is a yellow substance produced when red blood cells break down. While this process occurs in adults too, newborns have a higher production and faster breakdown of red blood cells in their first few days of life.

In adults, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract to be excreted from the body. However, a newborn's liver is often not mature enough to remove bilirubin quickly enough, leading to a buildup. This buildup of bilirubin causes the yellow discolouration characteristic of jaundice.

Jaundice typically appears within the first few days of life and usually goes away on its own within one to two weeks as the baby's liver matures. It is important for newborns to be checked for jaundice, especially during their first week of life, as severe jaundice can lead to serious health complications if left untreated.

There are several types of jaundice that can affect newborns, including:

• Physiological jaundice: This is the most common type and is considered a normal response to a newborn's limited ability to excrete bilirubin due to an immature liver. It typically appears within the first two to four days of life and usually resolves within two weeks.
• Breastfeeding jaundice: This occurs when a baby does not receive enough breast milk, often due to nursing difficulties or a low milk supply. Dehydration resulting from insufficient milk intake can lead to decreased urination and infrequent stools, causing a buildup of bilirubin.
• Breast milk jaundice: This type of jaundice is thought to be caused by substances in the breast milk that affect the breakdown of bilirubin in the liver. It typically appears after the first week of life and can last for several weeks.
• Jaundice from hemolysis: This occurs when there is an increased breakdown of red blood cells, such as in cases of ABO incompatibility or Rh disease, where there is a blood type mismatch between the mother and baby.
• Jaundice related to inadequate liver function: Prolonged liver dysfunction due to infection or other factors can also lead to jaundice.

Bilirubin is a yellow substance created when red blood cells break down

The liver sorts bilirubin, along with other waste products, into a fluid called bile. Bile is then passed out of the body through the intestines. Bilirubin is the pigment that gives bile its distinctive yellow colour. It also colours human faeces.

In newborns, the placenta removes bilirubin from the baby's body. After birth, the baby's liver takes over this role. It may take some time for the baby's liver to be able to do this efficiently. If the liver is not yet developed enough, it may not be able to get rid of the bilirubin fast enough, leading to a build-up of the substance. This build-up causes a condition called jaundice, in which the skin and eyes turn yellow.

Jaundice is very common in newborns and usually goes away on its own within a couple of weeks. However, it is important for a healthcare provider to check the baby for jaundice, as severe cases can lead to brain damage if left untreated. Treatment for jaundice may include phototherapy, in which the baby is placed under special blue lights to help break down the bilirubin, or in rare cases, an exchange transfusion of blood.

In adults, high bilirubin levels can be a sign of an underlying health condition, such as liver disease, gallstones, or hepatitis. A blood test can be used to measure bilirubin levels in the body.

Treatment for jaundice may be required if bilirubin levels are high

Treatment for Jaundice in Newborns

Jaundice is a common condition in newborns, characterised by a yellowing of the skin and eyes, which occurs when there is too much bilirubin in the blood. While jaundice usually clears up on its own within a couple of weeks, treatment may be required if bilirubin levels are high.

Treatment Options

Treatment for jaundice depends on the cause, the bilirubin levels, and the baby's age. If a baby's bilirubin levels are high or continue to rise, a healthcare provider may recommend phototherapy treatment. During phototherapy, the baby is placed under special blue lights with only a diaper and eye protection. This treatment helps the baby's liver break down excess bilirubin.

In rare cases when phototherapy is ineffective, an exchange transfusion may be necessary. This involves replacing some of the baby's blood with fresh, donated blood to quickly lower bilirubin levels.

Prevention and Monitoring

Although jaundice in newborns is normal and usually unavoidable, the risk of severe jaundice can be reduced by frequent feeding. Breastfed babies should be fed 8 to 12 times a day during their first week, while formula-fed babies should be given 1 to 2 ounces of formula every 2 to 3 hours, ensuring at least 8 feeds in a 24-hour period.

It is important for a newborn's bilirubin levels to be checked before leaving the hospital and again within the first five days of life, as this is when bilirubin levels are typically highest.

Complications

Untreated jaundice can lead to serious health complications such as cerebral palsy, deafness, and kernicterus, a type of brain damage. Therefore, it is crucial to monitor a newborn's condition and seek medical attention if jaundice persists or worsens.

Bilirubin levels are checked through blood tests or light machines

Newborn jaundice is a common condition that affects up to 60% of full-term babies and 80% of premature babies. It occurs when there is a high level of bilirubin in the blood, causing a yellow discolouration of the skin and eyes. Bilirubin is a yellow substance produced by the body when it breaks down old red blood cells. While mild jaundice usually clears up on its own within one to two weeks, high bilirubin levels can lead to serious complications and even brain damage if left untreated. Therefore, it is important to monitor bilirubin levels in newborns and provide treatment if necessary.

Bilirubin levels in newborns can be checked through blood tests or the use of light machines. Blood tests are typically used to confirm high bilirubin levels detected by light machines or to monitor bilirubin levels in newborns with jaundice. A small sample of blood is collected by pricking the baby's heel, and the test shows the total serum bilirubin (TSB) level. This method provides an accurate measurement of bilirubin levels in the blood.

Light machines, on the other hand, are non-invasive tools that can estimate bilirubin levels in the skin. These machines use a probe placed on the baby's head to measure the transcutaneous bilirubin (TcB) level. While light machines provide a quick and convenient way to screen for jaundice, they may not always be accurate, especially in babies with darker skin tones. Therefore, a blood test is often required to confirm high bilirubin levels detected by light machines.

In addition to these methods, healthcare providers may also use visual observation and physical examination to detect jaundice in newborns. They will look for the yellow discolouration of the skin and eyes, which typically starts on the face and then spreads to the chest, stomach, and legs. They may also gently press on the baby's forehead or nose to check for yellow discolouration of the skin. This method is particularly useful in detecting jaundice in babies with darker skin tones.

In summary, monitoring bilirubin levels in newborns is crucial to prevent complications and ensure the baby's health. Both blood tests and light machines are effective tools for checking bilirubin levels, and the choice of method depends on the specific situation and the baby's condition.

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