Ashli Loar

Hyperbilirubinemia

Hyperbilirubinemia is caused by the buildup of bilirubin in the body, bilirubin comes from red

blood cells when they are broken down in the spleen. When bilirubin is broken down in the spleen it

becomes unconjugated, and In order for bilirubin to leave the body it needs to become conjugated. The

liver conjugates the bilirubin, where it is then sent to the kidneys or the gall bladder to be excreted

through the urine or the feces. If there is some kind or problem in this process bilirubin can build up in

the body causing the skin and eyes to look yellow. Hyperbilirubinemia is common in infants after birth

due to many different kind of reasons. Hyperbilirubinemia, or jaundice, affects 60% of newborns and

80% of premature babies.

There are two different forms of jaundice: physiologic and nonphysiologic. Physiologic jaundice

is considered normal, it is not present at birth and can occur a few days after. This is caused by an

increase in breakdown of red blood cells. Red blood cells in infants break down much faster causing a

higher level of bilirubin that the liver has to conjugate. This is resolved within 5-7 days. Nonphysiologic

jaundice is caused by more serious complications and is seen in the first 24 hours after birth. This type of

jaundice can occur when mother’s blood type is different than infant’s blood type which is called Rh

incompatibility, if the infants and mothers blood mix then mothers antibodies can attack infant and can

break down infants red blood cells.

Jaundice can also be caused from being born preterm when the liver was not developed fully,

making it not able to conjugate bilirubin as efficiently. Some infants experience bruising during birth due

to some type of trauma, such as forceps or vacuuming. Bruising can increase risk of jaundice from all the

dead red blood cells in the infant’s body. Jaundice can be increased in infants that breast feed because

infants may not be getting enough nutrients causing them not to urinate or have bowel movements. If
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the bilirubin cannot be excreted then it will stay in the body and build up. Another breastfeeding

jaundice is called true breast milk jaundice. The cause is unknown, but is thought to be caused by

reabsorption of bilirubin in the intestines from breastmilk.

Lower levels of bilirubin is not considered dangerous. Bilirubin levels that rise too high and stay

high may cause bilirubin encephalopathy. Bilirubin encephalopathy is caused by buildup of bilirubin in

the brain and can cause kernicterus leading to brain damage or death.

Phototherapy is one treatment of jaundice, the infant is placed under a specific type of light in

which the bilirubin in the body can absorb, and helps it be excreted though kidneys and intestines. If

bilirubin levels become dangerously high exchange transfusions can be done, this is when infant’s blood

is removed and replaced with donor blood.

Ashli Loar

Mckinny, E.S., James, S.R., Murray, S.S., Nelson, K.A., Ashwill, J.W. (2000/2013). Maternal- Child Nursing

(4th ed.). St. Louis, MO: Saunders.