Bilirubin: What Is It and Why Are Pediatric Healthcare Providers So Concerned About the Number in Newborns?
Last week, I had a newborn that returned to our office for a simple weight and bilirubin check. The baby’s bilirubin level had been elevated the day prior, so we were rechecking it to ensure that it had not increased too quickly. The level was still elevated but not quite needing treatment, so I asked the parents to return in 1–2 days for a recheck. The mom looked at me and said, “What is bilirubin? No one has explained to us why we are getting it checked.” I then went on to explain what bilirubin is and why we closely monitor elevated levels in newborns. Read on to learn more.
What is Bilirubin?
Bilirubin is a yellowish pigment that is a byproduct of broken-down red blood cells (RBCs). Once these RBCs break down, they pass through the bloodstream to the liver for processing. The liver’s job is to remove bilirubin from the blood and then pass it on to the intestines so that it can leave the body.
Why Do Newborns Have a Hard Time Processing Bilirubin?
A newborn’s liver is immature and since the liver’s job is to remove bilirubin from the blood, a newborn’s liver may not be able to efficiently process bilirubin like an adult liver. Newborns also produce more RBCs and break down RBCs at a faster rate in their first few days of life, which can lead to an excess of bilirubin.
How Do I Know If My Baby Has Jaundice?
You can often tell if your baby has jaundice just by looking at their skin. Their skin will develop a yellowish color, which usually starts in the face and spreads down the body as bilirubin level increases. Other signs of increasing bilirubin are difficulty waking baby up, trouble feeding baby, increased fussiness, and decreased output of stool and urine. If any of these signs develop or if you are unsure, contact your baby’s healthcare provider right away.
Jaundice Risk Factors
- Prematurity: Baby born before 37 weeks
- East Asian or Mediterranean descent
- Sibling with jaundice
- Feeding difficulties: If baby is not feeding well, they are likely not urinating and stooling as they should
- Blood type: Mom has O blood type or Rh negative blood factor
What Happens If The Bilirubin Level is Too High?
If a baby’s bilirubin is severely high and goes untreated, it can lead to a condition called kernicterus, which causes brain damage. Kernicterus can lead to athetoid cerebral palsy, hearing loss, problems with vision and teeth, and sometimes even intellectual disabilities. This is why we as pediatric providers closely monitor bilirubin trends in newborns.
Jaundice Treatment
If the bilirubin level has reached the “light level,” baby will need treatment to help remove the bilirubin from their body. This is most often achieved with phototherapy. Phototherapy will either be administered in the hospital or can sometimes be delivered through light-therapy blankets at home. The light alters bilirubin to a form that can pass more easily through the body.
Supporting Baby to Excrete Bilirubin Naturally
Given that babies excrete bilirubin from their stool and urine, the best thing you can do as a parent is ensure that your baby is getting adequate feeds via breast milk or formula. This means feeding baby at least every 3 hours (and often times sooner) during those first 2 weeks of life. Monitoring baby’s output of urine and stool is also important. The amount of wet diapers should coincide with how many days old baby is up until about 6 to 8 days old. For example, on day 2 of life baby should have at least 2 wet diapers.
When you have a baby in the hospital, their bilirubin level will be measured at least once to establish a baseline. Depending on how high your baby’s bilirubin level is, your baby may need close monitoring of the level to ensure that it does not reach a dangerous level. According to the CDC, around 60% of babies will have jaundice. However, most full-term babies will not have jaundice severe enough to need treatment.
