What is hyperbilirubinemia in a newborn?

Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.

Bilirubin is made by the breakdown of red blood cells. It’s hard for babies to get rid of bilirubin at first. It can
build up in their blood, tissues, and fluids.

Bilirubin has a color. It makes a baby’s skin, eyes, and other tissues turn yellow (jaundice). Jaundice may first
appear when your baby is born. Or it may also show up any time after birth.

Which newborns are at risk for hyperbilirubinemia?

About 60% of full-term newborns get jaundice. So do 80% of premature babies. Babies born to mothers with
diabetes or Rh disease are more likely to have this condition.

What are the symptoms of hyperbilirubinemia in a newborn?

Symptoms can occur a bit differently in each child. They can include:

 Yellowing of your baby’s skin and the whites of his or her eyes. This often starts on a baby’s face and
moves down his or her body.

 Poor feeding
Lack of energy

Causes

Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. Bilirubin, which is

responsible for the yellow color of jaundice, is a normal part of the pigment released
from the breakdown of "used" red blood cells.

Newborns produce more bilirubin than adults do because of greater production and
faster breakdown of red blood cells in the first few days of life. Normally, the liver filters
bilirubin from the bloodstream and releases it into the intestinal tract. A newborn's
immature liver often can't remove bilirubin quickly enough, causing an excess of
bilirubin. Jaundice due to these normal newborn conditions is called physiologic
jaundice, and it typically appears on the second or third day of life.

Other causes

An underlying disorder may cause infant jaundice. In these cases, jaundice often
appears much earlier or much later than does the more common form of infant jaundice.
Diseases or conditions that can cause jaundice include:

 Internal bleeding (hemorrhage)

  An infection in your baby's blood (sepsis)

 Other viral or bacterial infections

 An incompatibility between the mother's blood and the baby's blood

 A liver malfunction

 An enzyme deficiency
An abnormality of your baby's red blood cells that causes them to break down rapidly.

Risk factors

Major risk factors for jaundice, particularly severe jaundice that can cause
complications, include:

 Premature birth. A baby born before 38 weeks of gestation may not be able to
process bilirubin as quickly as full-term babies do. Premature babies also may feed
less and have fewer bowel movements, resulting in less bilirubin eliminated
through stool.

 Significant bruising during birth. Newborns who become bruised during delivery
gets bruises from the delivery may have higher levels of bilirubin from the
breakdown of more red blood cells.

 Blood type. If the mother's blood type is different from her baby's, the baby may
have received antibodies through the placenta that cause abnormally rapid
breakdown of red blood cells.

 Breast-feeding. Breast-fed babies, particularly those who have difficulty nursing or

getting enough nutrition from breast-feeding, are at higher risk of jaundice.
Dehydration or a low caloric intake may contribute to the onset of jaundice.
However, because of the benefits of breast-feeding, experts still recommend it. It's
important to make sure your baby gets enough to eat and is adequately hydrated.

How is hyperbilirubinemia in a newborn diagnosed?

The timing of when your child’s jaundice first starts matters. It may help his or her healthcare provider make a
diagnosis.

 First 24 hours. This type of jaundice is often serious. Your child will likely need treatment right away.
 Second or third day. This is often physiologic jaundice. Sometimes it can be a more serious type of jaundice.
It's important to be sure the baby is getting enough milk at this point.

 Toward the end of the first week. This type of jaundice may be from breastmilk jaundice but may be due
to an infection or other rare serious problems.

 In the second week. This is often caused by breastmilk jaundice but may be caused by rare liver problems.

How is hyperbilirubinemia in a newborn treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe
the condition is.

Phototherapy
Bilirubin absorbs light. High bilirubin levels often decrease when a baby is put under special blue spectrum
lights. This is called phototherapy. Your child may get this treatment in the day and night. It may take several
hours for it to start working. During light treatment, your baby’s eye will be protected. Your baby’s healthcare
provider will check your baby’s temperature. He or she will also test your baby’s bilirubin levels. This will tell
if phototherapy is working.

Fiber optic blanket

A fiber optic blanket is another form of phototherapy. The blanket is usually put under your baby. It may be
used alone or with regular phototherapy.

Exchange transfusion
This treatment removes your baby’s blood that has a high bilirubin level. It replaces it with fresh blood that has
a normal bilirubin level. This raises your baby’s red blood cell count. It also lowers his or her bilirubin
level. During the procedure, your baby will switch between giving and getting small amounts of blood. This
will be done through a vein or artery in the baby's umbilical cord. It is only done in an intensive care nursery
when bilirubin levels are extremely high. Your baby may need to have this procedure again if his or her
bilirubin levels stay high.

Key points about hyperbilirubinemia in the newborn

 Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.

 About 60% of full-term newborns and 80% of premature babies get jaundice.

 The most common symptom is yellowing of your baby’s skin and the whites of his or her eyes.

 The timing of when your child’s jaundice first starts matters. It can help his or her healthcare provider make a
diagnosis.

 Make sure you feed your baby early and often.

 Spotting jaundice early and getting treatment right away are key. This can stop your child’s bilirubin from
rising to dangerous levels.

 EPIDEMIOLOGY

What is the incidence of neonatal jaundice in the US?

Updated: Dec 27, 2017
 Author: Thor WR Hansen, MD, PhD, MHA, FAAP; Chief Editor: Muhammad
Aslam, MD more...
 References
An estimated 50% of term and 80% of preterm infants develop jaundice,
typically 2-4 days afer birth. [3] Neonatal hyperbilirubinemia is extremely
common because almost every newborn develops an unconjugated serum
bilirubin level of more than 30 µmol/L (1.8 mg/dL) during the first week of life.
Incidence figures are difficult to compare because authors of different studies
do not use the same definitions for significant neonatal hyperbilirubinemia or
jaundice. In addition, identification of infants to be tested depends on visual
recognition of jaundice by health care providers, which varies widely and
depends both on observer attention and on infant characteristics such as race
and gestational age. [12]
Incidence varies with ethnicity and geography. Incidence is higher in East
Asians and American Indians and lower in Africans. Greeks living in Greece
have a higher incidence than those of Greek descent living outside of Greece.
Updated: Dec 27, 2017

 Author: Thor WR Hansen, MD, PhD, MHA, FAAP; Chief Editor: Muhammad Aslam, MD