The norm of bilirubin in newborns and what to do with its elevated level

The breakdown of red blood cells by the body results in the production of bilirubin. While it’s normal for bilirubin levels in newborns to be higher than in adults, it’s still important to monitor these levels. A condition called jaundice, which causes the baby’s skin and eyes to appear yellow, could result from them rising too high.

The majority of newborn elevated bilirubin cases are transient and go away on their own. To avoid complications, therapy might be required in specific situations. Parents can handle the situation with confidence if they are aware of what constitutes a normal range for bilirubin and know what actions to take if levels are elevated.

This post will discuss normal newborn bilirubin levels and what to do if your baby has elevated levels so that their health and wellbeing are safeguarded against any risks.

Because jaundice is common in the first few days of life, elevated bilirubin levels in newborns are closely monitored. It’s crucial for parents to understand the normal range and when to seek medical attention, even though the majority of cases are benign and go away on their own. Light therapy and more frequent feedings are two easy ways to keep your baby healthy and lower bilirubin levels.

What is bilirubin?

A pigment called bilirubin is created in the human body when hemoglobin is broken down. It normally binds to substances made in the liver and excretes itself along with feces and urine. Small amounts of this type of pigment are always found in human blood.

Types

1. Indirect. Such a fraction is also called free or unbound. This bilirubin does not dissolve in water and is quite toxic. It easily penetrates cells and disrupts their metabolic processes.
2. Direct. Since this pigment fraction binds to glucuronic acid in the liver, it is also called bound. After binding, this bilirubin becomes water-soluble, due to which it easily leaves the body.
3. Total. This indicator shows the total amount of bound and free bilirubin.

How the analysis is carried out?

The baby’s umbilical cord blood is drawn as soon as possible after birth to measure bilirubin levels and other markers. Moreover, heel blood can be used for testing newborns. It is advised that the baby not feed for four hours prior to receiving blood. After the blood is put in a specialized test tube, its levels of total bilirubin and, if required, its fractions are measured.

Newborn bilirubin norms by day in the table

Age

The highest indication in μmol for each liter of blood

Initial hours following birth

Why are the fluctuations in norms so strong?

These symptoms are linked to the child’s body producing more bilirubin and excreting it more slowly. Hemoglobin in a fetus’s red blood cells in the mother’s womb is structurally different from that of adults and children who have already been born, allowing for improved oxygen transfer. This type of hemoglobin is known as fetal. After birth, it starts to degrade because it is no longer required. It is then released into the blood and changes into bilirubin. This results in the first few weeks of life having a high concentration of bilirubin.

Reasons for an increased level

The following factors may manifest as an elevated bilirubin level:

• Prematurity of the baby.
• Development of diabetes in the expectant mother.
• Acute diseases of the pregnant woman.
• Hypoxia in the baby during gestation.
• Asphyxia during childbirth.
• Premature onset of labor.
• Increased amount of estrogen in breast milk.
• Incompatibility of the blood group of the mother and baby.
• Rhesus conflict during gestation.
• Refusal to breastfeed immediately after birth.
• Significant weight loss of the child in the first days after birth.
• Pathologies of intrauterine development.
• Infectious liver disease.
• Mechanical type of jaundice.
• Intestinal obstruction.
• Destruction of red blood cells due to genetic diseases.
• Use of medications to stimulate labor.
• Liver dysfunction in the baby.
• Hormonal failure in the baby.

Types of jaundice according to the indicator

The term "physiological" jaundice affects the majority of newborns. It emerges when bilirubin reaches the skin’s outermost layers, which happens when this pigment’s level rises to more than 120 μmol/l in healthy full-term babies and more than 85 μmol/l in premature babies.

A diagnosis of "pathological jaundice" is made when the bilirubin level rises to more than 256 μmol/l in full-term newborns and more than 172 μmol/l in premature babies. In this condition, there is an increase in bilirubin levels of over 5 μmol/l per hour, whereas in physiological jaundice, this increase does not surpass 3.4 μmol/l per hour.

The following table lists the primary signs of physiological jaundice and illustrates how it differs from pathological jaundice:

Jaundice that is physiological

Unhealthy yellowish skin

Begins on day two and ends on day five of life.

May start on the first day of life and end on the fourteenth day of life.

Usually lasts two to three weeks.

Extends beyond two weeks

The severity of jaundice and the bilirubin level start to decline on the fourth day of life.

Characterized by a path that is wave-like

Face and upper body are the first areas to turn yellow.

The feet and palms turn orange, and the body turns yellow below the navel.

The welfare of the child is not jeopardized

The child might exhibit symptoms of nervous system depression or be extremely excited.

The hue of the urine and feces is normal.

Feces can occasionally lighten, but urine can darken.

There is no impairment to liver function.

Potential dysfunction of the liver

Treatment: how to lower the indicator?

Phototherapy is the most straightforward, widely available, and safest method for treating jaundice in infants. A child who is at risk of having toxic levels of bilirubin is exposed to special lamps for a specific amount of time. The light from these lamps converts indirect bilirubin into lumirubin, a non-toxic substance. Bilirubin leaves the baby’s body in the form of urine and feces in less than 12 hours.

Phototherapy is administered while taking feeding pauses. The infant should be placed 20–40 centimeters away from the light source, with a light-blocking cloth covering his eyes and genitalia. Treatment side effects may include sunburn, diarrhea, fever, dehydration, and skin peeling. It’s critical to keep the water balance in a newborn’s body constant in order to get rid of them.

It is equally important to nurse the infant frequently and as soon as possible because this encourages the child’s intestines to expel a meconium that contains a significant amount of bilirubin.

Treatment for pathological jaundice is related to:

• Infusion therapy. Special solutions are administered intravenously to the child, and if the condition of the baby is complex, then the crumb is poured blood.
• Enterosorbents. The baby is given SMECTU, Enterosgel and other drugs to prevent the reverse absorption of bilirubin from the intestines.
• Specific treatment Depending on the identified pathology.

What can be the consequences of high bilirubin?

The primary risk associated with elevated bilirubin levels in infants’ blood is the detrimental impact on nerve cells and other organ systems. Encephalopathy, an increase in the spleen and liver, drowsiness, a drop in blood pressure, the onset of seizures, delayed development, hearing issues, and even paralysis are possible outcomes.

Komarovsky"s opinion

According to a renowned pediatrician, approximately 50% of newborns experience physiological jaundice, which typically disappears by the time the baby reaches the 10–14 day mark.

A well-known physician also points out that breastfeeding jaundice affects a lot of newborns. With it, the infant’s health is maintained and their weight growth is regular. When feeding is stopped for a day, the bilirubin level drops right away, which is how this type of jaundice is identified.

It’s critical to comprehend newborns’ bilirubin levels to guarantee their health and wellbeing. After birth, bilirubin levels often rise slightly; however, if they do so excessively, this may indicate jaundice and necessitate medical attention.

Do not become alarmed if your baby has an elevated bilirubin level. It is imperative that you adhere to your physician’s advice, which may involve phototherapy or other forms of treatment. When given prompt care, the baby’s condition usually improves quickly.

Early on in life, monitoring bilirubin levels aids in the early detection of any potential problems. Maintaining regular communication with your pediatrician is essential to ensuring your child’s continued health and well-being.

Video on the topic

Jaundice in newborns. Bilirubin numbers. © Natalia Shilova.

Jaundice in newborns: causes, is treatment necessary

Jaundice in newborns: in what cases to worry?