Bilirubin Checks For Newborns: A Necessary Procedure?

Jaundice is a common condition in newborn babies, characterised by a yellow discolouration of the skin and eyes. It is caused by high levels of bilirubin in the blood, which occurs when the liver is unable to break down and remove bilirubin efficiently. While jaundice usually resolves on its own within a couple of weeks, it is important for newborns to be checked for the condition to prevent rare but serious complications such as kernicterus, a type of brain damage.

Bilirubin checks are necessary to prevent brain damage

Bilirubin is a yellow substance produced when red blood cells break down. While a mother is pregnant, her liver removes bilirubin for her baby. After birth, the baby's liver must start removing bilirubin. If the baby's liver is not developed enough, it may not be able to get rid of bilirubin, leading to a build-up known as jaundice.

Jaundice

Jaundice is very common and usually goes away on its own. However, severe jaundice can lead to brain damage if left untreated. It is therefore important that a baby's healthcare provider checks them for jaundice. Bilirubin checks are necessary to prevent brain damage.

Bilirubin Checks

Bilirubin levels can be estimated by placing a probe on a baby's head. If the level is high, a blood test will be ordered to confirm the results. The American Academy of Pediatrics uses a newborn jaundice level chart to determine if a baby needs treatment.

Treatment

Treatment for jaundice is usually not necessary. Mild levels of jaundice typically go away on their own as a baby's liver continues to develop. Feeding a baby often can encourage bowel movements, which help the baby's body get rid of excess bilirubin.

If a baby's bilirubin level is high or continues to rise, their healthcare provider may recommend phototherapy treatment. During phototherapy, a baby is placed under special blue lights. The lights help the baby's liver get rid of excess bilirubin.

In rare cases, a blood transfusion may be required.

Newborn jaundice is common and treatable

Newborn jaundice is a common condition that affects up to 60% of full-term babies and 80% of premature babies during their first week of life. It is characterised by a yellow discolouration of the skin and eyes, caused by high levels of bilirubin in the blood. Bilirubin is a yellow substance created when red blood cells break down, which the liver then helps to break down and remove from the body.

Newborn jaundice usually occurs because a baby's liver isn't mature enough to remove bilirubin from the bloodstream efficiently. In most cases, jaundice is not serious and will go away on its own within one to two weeks. However, it is important for a healthcare provider to check for jaundice as severe cases can lead to brain damage if left untreated.

There are several types of newborn jaundice, including:

• Physiological jaundice: the most common type, which typically develops by the second or third day of life and goes away on its own within two weeks.
• Breastfeeding jaundice: more common in breastfed babies, it occurs during the first week of life when babies don't get enough breast milk or due to nursing difficulties.
• Breast milk jaundice: caused by substances in breast milk affecting how the baby's liver breaks down bilirubin; it may appear after the first week of life and can last a month or more.

Treatment for newborn jaundice is usually not necessary, but in some cases, phototherapy may be recommended. This involves placing the baby under special blue lights to help break down bilirubin in the skin. In rare cases, an exchange transfusion may be required, where some of the baby's blood is replaced with fresh, donated blood.

To prevent and manage newborn jaundice, it is important to ensure adequate feeding. Breastfed infants should be fed eight to 12 times a day during the first week, while formula-fed infants should have one to two ounces of formula every two to three hours. Regular follow-up appointments with the baby's doctor are also recommended to monitor bilirubin levels and check for any complications.

Bilirubin levels are tested using blood tests or bilirubinometers

Bilirubin is a yellow substance produced by the body when it breaks down old red blood cells. While a pregnant woman's liver removes bilirubin for the baby, after birth, the baby's liver must begin removing bilirubin. If the baby's liver isn't developed enough, it may not be able to get rid of bilirubin, leading to a buildup known as jaundice, which causes a yellowing of the skin and eyes. While jaundice is common and usually not serious, severe jaundice can lead to brain damage if left untreated.

In some cases, bilirubin levels can also be estimated non-invasively using a probe placed on the baby's head to measure the transcutaneous bilirubin (TcB) level. If this level is high, a blood test is then performed to confirm the results.

Bilirubin can also be measured through a urine test, known as a bilirubin urine test, which is done as part of a comprehensive urinalysis. This test is typically ordered if there is visible jaundice or dark-coloured urine.

Testing bilirubin levels is important to monitor liver health and identify any potential issues, such as liver disease or damage, or conditions that affect the breakdown of red blood cells, like haemolytic anaemia.

Newborns produce more bilirubin than adults

The liver typically filters bilirubin from the bloodstream and releases it into the intestinal tract. However, a newborn's immature liver often cannot remove bilirubin quickly enough, leading to an excess of bilirubin in the blood. This excess bilirubin can cause jaundice, a common condition that makes a baby's skin and eyes appear yellow. Jaundice usually occurs between the second and fourth day after birth and typically goes away within two weeks.

While jaundice is usually not serious, it is important for a healthcare provider to check the baby's bilirubin levels to ensure they do not rise to dangerous levels. Severe jaundice can lead to serious health complications such as kernicterus, a type of brain damage. Treatment for jaundice may include phototherapy, where the baby is placed under special blue lights to help break down the excess bilirubin. In rare cases, an exchange transfusion may be necessary, where the baby's blood is replaced with fresh, donated blood.

To check for jaundice, gently press on the baby's forehead or nose. If the skin appears yellow where you pressed, it is likely that the baby has mild jaundice. It is important to examine the baby in good lighting conditions, preferably in natural daylight.

Recommendations for Bilirubin Checks in Newborns

The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to twelve hours while in the hospital. Additionally, all babies should be seen by a healthcare provider in the first five days of life to check for jaundice. For infants who spend less than 24 hours in the hospital, a follow-up appointment should be made within 72 hours of discharge.

Breastfed babies are at a higher risk of jaundice

Jaundice is a common condition in newborns that causes a yellowing of the skin and eyes due to elevated bilirubin levels in the blood. While jaundice can occur in all newborns, breastfed babies are at a higher risk of developing this condition, particularly during the first week of life when breastfeeding is being established.

Causes of Jaundice in Breastfed Babies

There are two main types of jaundice associated with breastfeeding: breastfeeding jaundice and breast milk jaundice.

Breastfeeding Jaundice

Breastfeeding jaundice occurs when a newborn does not receive enough breast milk during the first week of life, leading to dehydration. This can be due to nursing difficulties or because the mother's milk supply has not yet come in. As a result, the baby's body reabsorbs bilirubin from the intestines, causing a buildup in the blood.

Breast Milk Jaundice

Breast milk jaundice typically appears after the first week of life and can last for several weeks. It is believed to be caused by substances in the mother's milk that affect the baby's liver's ability to process and break down bilirubin. While the exact mechanism is not fully understood, it is thought that certain factors in breast milk may inhibit the liver's ability to process bilirubin, leading to elevated levels in the blood.

Treatment for Jaundice in Breastfed Babies

The treatment for jaundice in breastfed babies depends on the severity of the condition. In most cases, breastfeeding can and should continue, and increasing the frequency of feedings can help reduce bilirubin levels. Phototherapy, or light therapy, is also a common treatment option, as it helps break down bilirubin in the skin.

In some cases, temporary interruption of breastfeeding for a brief period may be recommended to help diagnose and treat breast milk jaundice. During this time, the baby may be fed expressed breast milk, donor human milk, or infant formula. It is important to work with a healthcare provider to determine the best course of treatment for each individual case.

Prevention and Monitoring

While jaundice in breastfed babies is common, it is important to monitor the baby's condition and seek medical attention if jaundice is suspected. Feeding the baby frequently (8-12 times per day) during the first week of life can help reduce the risk of jaundice and ensure adequate nutrition.

If jaundice is observed, a healthcare provider should evaluate the baby and perform the necessary tests to determine the cause and severity of the condition. Early detection and treatment can help prevent potential complications and ensure the baby's health and well-being.

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