Bilirubin Levels In Newborns: Understanding The Norms And Deviations

Bilirubin is a yellow substance produced by the breakdown of red blood cells. It is removed from the blood by the liver and passed out of the body. However, newborn babies often experience jaundice, a yellowing of the skin and eyes, due to elevated bilirubin levels in their blood. This condition arises because a newborn's liver is not yet fully developed and thus cannot remove bilirubin effectively. While jaundice typically resolves on its own within a couple of weeks, it can sometimes lead to severe health issues if left untreated. Therefore, monitoring bilirubin levels in newborn babies is crucial to ensure timely intervention and prevent potential complications.

Jaundice in newborns

Jaundice is a common condition in newborn babies that causes a yellowing of the skin and eyes. This occurs when there is a build-up of bilirubin in the baby's blood, which happens when their liver is not yet developed enough to remove it effectively.

Bilirubin is a yellow substance produced when red blood cells break down. During pregnancy, the placenta removes bilirubin from the baby's body, but after birth, the baby's liver must take over this role. In some cases, the liver may not be developed enough to remove bilirubin quickly enough, leading to a build-up.

Types of jaundice

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

• Physiological jaundice: This is the most common type of jaundice and is considered normal. It typically develops within the first few days of life and goes away on its own within two weeks.
• Breastfeeding jaundice: This type of jaundice occurs when a baby does not get enough breast milk, often due to nursing difficulties or the mother's milk not yet being established. It may take longer to resolve.
• Breast milk jaundice: This type of jaundice is caused by substances in the breast milk that affect how the baby's liver breaks down bilirubin. It usually appears after the first week of life and can last for several weeks.
• Severe newborn jaundice: This may occur due to various conditions, such as abnormal blood cell shapes, blood type mismatch between mother and baby, bleeding underneath the scalp after a difficult delivery, or higher levels of red blood cells.

Symptoms of jaundice

In addition to the yellowing of the skin and eyes, other symptoms of jaundice in newborns can include dark, yellow urine and pale-coloured poo. Jaundice typically develops within the first few days after birth and usually improves within about two weeks without treatment.

Treatment for jaundice

Treatment for jaundice is usually not necessary, as it often resolves on its own. However, in cases of very high bilirubin levels, treatment may be recommended to reduce the risk of brain damage. The two main treatments are phototherapy, where special lights are used to alter the bilirubin so it can be broken down by the liver, and exchange transfusion, where the baby's blood is replaced with blood from a matching donor.

Physiological jaundice

The first sign of jaundice is a yellow colour on the baby's skin, which is best seen in natural lighting. It usually appears on the baby's face first and then spreads to other parts of the body as the bilirubin level increases.

To prevent severe jaundice, it is recommended to feed the baby frequently. Frequent feedings stimulate regular bowel movements, which help the baby eliminate excess bilirubin. For breastfed babies, it is recommended to breastfeed eight to twelve times a day during the first week, while formula-fed babies should be fed one to two ounces every two to three hours, ensuring at least eight feeds in a 24-hour period.

Breastfeeding jaundice

To prevent breastfeeding jaundice, it is recommended to initiate breastfeeding as soon as possible after birth, preferably within the first hour. Early and frequent feedings help to eliminate bilirubin from the baby's body, as it is excreted in the infant's stools. Colostrum, the sticky yellow fluid produced before milk comes in, acts as a laxative, further aiding in the elimination of bilirubin.

If breastfeeding jaundice occurs, it is important to work with a lactation consultant to ensure the baby is latching properly and receiving adequate amounts of milk. Increasing feedings to 8-12 times a day can help reduce bilirubin levels, as more frequent feedings result in increased bowel movements, which help secrete the buildup of bilirubin.

In most cases, breastfeeding jaundice can be resolved with increased feedings and proper latching techniques, without the need to interrupt breastfeeding or supplement with formula. It is important to closely monitor the baby's bilirubin levels and seek professional help if jaundice is suspected or persists.

Breast milk jaundice

Jaundice is caused by a buildup of bilirubin in a baby's blood. Bilirubin is a yellow substance that is 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 begin removing bilirubin. If the baby's liver is not developed enough, it may not be able to get rid of the bilirubin, leading to a buildup that causes the skin and eyes to turn yellow.

The exact mechanism leading to breast milk jaundice is unknown, but it is believed to be caused by a substance in breast milk that inhibits the infant's liver from processing bilirubin. This type of jaundice is genetic and tends to run in families. It occurs just as often in male and female infants and affects about a third of all newborns who are exclusively breastfed.

Treatment for breast milk jaundice depends on several factors, including the baby's bilirubin level, the rate at which the level is rising, whether the baby was born prematurely, and how the baby is feeding. Treatment options may include phototherapy, fluids, immunoglobulin, and exchange blood transfusion.

It is important to monitor a baby's bilirubin levels and seek medical attention if the jaundice persists or worsens.

Kernicterus

In newborn babies with very high levels of bilirubin in the blood, the bilirubin can cross the thin layer of tissue that separates the brain and blood (the blood-brain barrier). This can cause irreversible neurological damage, ranging from clinically unnoticeable effects to severe brain damage and even death.

Initial symptoms of kernicterus in babies include lethargy (sleepiness), brief pauses in breathing (apnoea), and their muscles becoming unusually floppy. As kernicterus progresses, additional symptoms can include fits (seizures), muscle spasms that can cause arching of the back and neck, and involuntary twitching of different body parts. If significant brain damage occurs before treatment, a child can develop serious and permanent problems, such as cerebral palsy, hearing loss, learning disabilities, and poor development of the teeth.

The key to preventing kernicterus is early diagnosis and treatment of jaundice. Treatment for kernicterus involves using an exchange transfusion, as is done in the treatment of newborn jaundice. Phototherapy is also used to reduce bilirubin levels.

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