Bilirubin Levels In Newborns: Is 15 A Safe Number?

Jaundice, a common condition in newborns, is caused by elevated bilirubin levels in the blood, resulting in yellowing of the skin and eyes. While it usually resolves on its own, high bilirubin levels can be dangerous and require medical attention. This article will explore whether a newborn's bilirubin level of 15 is normal or cause for concern.

What is considered a normal bilirubin level in newborns?

Bilirubin is a yellow substance produced when the body breaks down old red blood cells. In newborns, jaundice, a common condition, is caused by a buildup of bilirubin in the blood. This happens because their livers are not yet developed enough to get rid of the bilirubin.

The normal range of bilirubin in newborn babies is approximately 0.3 mg/dL to 1.0 mg/dL within the first 24 hours of birth. This is considered "physiological jaundice" and is typically not serious, disappearing within 10-14 days of birth with no lasting effects on the baby.

Jaundice will normally appear first on the newborn's face, then move down the body to the chest, abdomen, arms, and legs. It is best seen in natural light and can be harder to detect in dark-skinned babies.

If a newborn's bilirubin levels reach above 15 mg/dL (25-48 hours old), 18 mg/dL (49-72 hours old), or 20 mg/dL (above 72 hours old), phototherapy is usually administered as treatment.

In rare cases, if phototherapy is ineffective, an exchange transfusion may be required, in which some of the baby's blood is replaced with fresh, donated blood.

It is important to monitor a newborn's bilirubin levels during the first week of life, as very high levels can be toxic for the development of the central nervous system and can lead to serious health conditions such as cerebral palsy, deafness, and kernicterus, a type of brain damage.

What causes high bilirubin levels in newborns?

Newborn jaundice occurs when a baby has a high level of bilirubin in their blood. Bilirubin is a yellow substance produced when the body breaks down old red blood cells. During pregnancy, the placenta removes bilirubin from the baby's blood, but after birth, the baby's liver takes over this role.

There are several factors that can cause high bilirubin levels in newborns:

Physiologic Jaundice

This is the most common type of jaundice in newborns and is considered normal. It occurs during the first few days of life when babies are unable to get rid of much bilirubin due to their livers' immature state. It typically appears on the second or third day of life and goes away within two weeks.

Breastfeeding Failure Jaundice

Some babies don't breastfeed well initially, leading to dehydration and decreased urination. This causes a build-up of bilirubin in the body. It is more common in babies born between 34 to 36 weeks of pregnancy or those who had a difficult start, such as being separated from their mother.

Jaundice from Hemolysis

If a baby has Rh disease or a different blood type from the mother, they may experience jaundice due to the breakdown of red blood cells (hemolysis). This can also occur in cases of excessive red blood cells or rare problems where the red blood cells are more fragile than normal.

Jaundice Caused by Poor Liver Function

Jaundice can result from poor liver function, which may be due to an infection or other factors. The liver is primarily responsible for removing bilirubin, so a problem with the liver can lead to higher bilirubin levels.

Breast Milk Jaundice

Substances in breast milk can affect how the baby's liver breaks down bilirubin, leading to a build-up. This type of jaundice typically occurs after the first week of life and may last for several weeks.

Risk Factors

Certain risk factors can increase the likelihood of high bilirubin levels and jaundice in newborns. These include:

• Prematurity: Premature babies are more likely to develop jaundice than full-term babies.
• Maternal factors: Blood type incompatibility, breastfeeding, certain drugs, ethnicity, and maternal illnesses like gestational diabetes can contribute.
• Neonatal factors: Birth trauma, drug use, excessive weight loss after birth, infections, infrequent feedings, male gender, and polycythemia are among the factors.
• Genetic or inherited disorders: Various genetic conditions can affect bilirubin levels.
• Bruising from a difficult birth: Bruising can lead to higher levels of bilirubin as more red blood cells break down.
• Blood type mismatch: A blood type mismatch between the mother and baby can cause abnormally rapid red blood cell breakdown.

It is important to monitor bilirubin levels in newborns and seek medical advice if there are concerns about jaundice or high bilirubin levels.

How is high bilirubin treated in newborns?

High bilirubin in newborns, also known as hyperbilirubinemia, is typically treated using phototherapy. This involves placing the baby under special blue lights, fully undressed except for a diaper and eye protection, to help break down the excess bilirubin in the skin. The treatment can take place during the day and night and usually lasts one to two days. The lights are positioned 15 to 20 cm away from the infant to ensure optimal effectiveness.

Phototherapy is considered safe and is often recommended when bilirubin levels reach 15 mg/dL in infants 25 to 48 hours old, 18 mg/dL in infants 49 to 72 hours old, and 20 mg/dL in infants older than 72 hours. In some cases, a fiber optic blanket, which contains tiny bright lights, may be placed under the baby to provide additional phototherapy.

If phototherapy is not effective or bilirubin levels remain elevated, an exchange transfusion may be necessary. This involves replacing the baby's blood with fresh, donated blood to lower bilirubin levels and increase red blood cell count. Exchange transfusion is a rare procedure, typically only performed in intensive care nurseries when bilirubin levels are dangerously high.

To support the treatment of high bilirubin, it is crucial to ensure adequate feeding. Breastfed infants should be fed eight to twelve times a day during their first week, while formula-fed infants should receive one to two ounces of formula every two to three hours, with at least eight feeds in a 24-hour period.

In very rare cases, a liver transplant may be required if the underlying cause of high bilirubin is related to severe liver dysfunction.

What are the risks of untreated high bilirubin in newborns?

Untreated high bilirubin levels in newborns, known as hyperbilirubinemia, can pose serious health risks. This condition occurs when there is an excessive amount of bilirubin in the baby's blood, leading to a yellowing of the skin and eyes known as jaundice. While mild jaundice is common and often resolves without treatment, high bilirubin levels can have more severe consequences if left untreated. Here are some of the risks associated with untreated high bilirubin in newborns:

• Brain Damage: High bilirubin levels can lead to a condition called kernicterus, which is a type of brain damage. Bilirubin can cross the blood-brain barrier and deposit in the brain tissue, causing neurological issues such as developmental and motor delays, sensorineural deafness, and mild mental retardation.
• Cerebral Palsy: Untreated high bilirubin levels can increase the risk of cerebral palsy, a neurological disorder affecting body movement and muscle coordination.
• Hearing Loss: High bilirubin levels, if left untreated, can lead to high-frequency hearing loss or even deafness in severe cases.
• Seizures: In some cases, untreated high bilirubin levels can result in seizures.
• Liver Dysfunction: Jaundice itself can be a sign of poor liver function. If left untreated, high bilirubin levels can further impair liver function, as the liver is responsible for removing bilirubin from the body.
• Other Health Complications: Untreated hyperbilirubinemia can be associated with severe illnesses such as hemolytic disease, metabolic and endocrine disorders, anatomical abnormalities of the liver, and infections.

It is important to note that most cases of jaundice are mild and resolve within a couple of weeks. However, it is crucial to monitor bilirubin levels and seek medical advice if levels are elevated, as early intervention can prevent these potential risks and ensure the baby's well-being.

How can you tell if a newborn has high bilirubin?

High bilirubin levels in newborns, also known as neonatal hyperbilirubinemia, can be a cause for concern and may indicate jaundice. Jaundice is a common condition in newborns that typically arises when the baby's liver is not fully developed to efficiently remove bilirubin, a yellow substance created during the breakdown of red blood cells, from their bloodstream. While mild jaundice is usually not serious and often resolves within a couple of weeks, high bilirubin levels can lead to severe jaundice and potential health complications.

Yellow Discoloration of the Skin and Eyes (Jaundice)

The most noticeable sign of high bilirubin in newborns is jaundice, characterized by a yellow discoloration of the skin and eyes. This yellowing typically appears within the first few days of life, starting with the face and then extending to the chest, abdomen, arms, legs, and soles of the feet. Jaundice is best observed in natural lighting, such as near a window, and can be more challenging to detect in babies with darker skin tones.

Blood Tests

Blood tests are the most accurate way to determine bilirubin levels in newborns. Bilirubin levels can be measured by taking a small blood sample by pricking the baby's heel. This is particularly important when jaundice is suspected or when the newborn exhibits other concerning symptoms.

Transcutaneous Bilirubin Measurement

Before performing a blood test, healthcare providers may use a non-invasive method called transcutaneous bilirubin measurement. This involves placing a probe on the baby's head to estimate the bilirubin level. If the level is high, a blood test will be ordered to confirm the results.

Risk Factors

Certain risk factors can increase the likelihood of high bilirubin levels and severe jaundice in newborns. These include:

• Premature birth: Babies born before 38 weeks of gestation may have immature livers that are not yet fully capable of processing bilirubin efficiently.
• Bruising during birth: Significant bruising during delivery can lead to higher levels of bilirubin due to increased red blood cell breakdown.
• Blood type mismatch: If the mother's blood type differs from the baby's, the baby may have received antibodies through the placenta that cause rapid red blood cell breakdown.
• Breastfeeding difficulties: Breastfed babies, especially those who have trouble nursing or are not getting enough milk, may be at higher risk of jaundice due to dehydration or low caloric intake.
• Race: Studies indicate that babies of East Asian ancestry are at an increased risk of developing jaundice.

Other Symptoms

In some cases, high bilirubin levels and severe jaundice may present with additional symptoms, including:

• Listlessness or difficulty awakening
• Poor feeding or weight gain
• High-pitched cries
• Arching of the neck and body
• Involuntary and uncontrolled movements

If you suspect that a newborn has high bilirubin levels or jaundice, it is important to consult a healthcare professional for proper evaluation and treatment. They will assess the baby's condition, perform the necessary tests, and recommend appropriate interventions, such as phototherapy or exchange transfusion, if required.

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