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Healthy Baby Happy Parents
Jaundice
A common condition in newborns caused by the build up of a chemical called bilirubin in which the skin and whites of the eyes become yellow is called Jaundice. Bilirubin is the natural by-product of red blood cell metabolism and is ongoing throughout life. In the womb, bilirubin is processed in the placenta. After birth, bilirubin is processed in the liver and eliminated in the stool; however, it takes days before the liver wakes up and functions adequately to process bilirubin.
The natural rise and fall of bilirubin in a newborn is called physiologic (see the graph at left). The level rises and peaks by the 3rd or 4th day. Then it decreases. The future value on any particular day or the rate of rise cannot be predicted; therefore, follow up with your Primary care Provider is essential.
Bilirubin values are measured transcutaneously with a hand held bilimeter. and are called TcBili levels. The first value is done either in preparation for discharge or when jaundice is noted by the nursery nurse.
If a baby has early elevation of their bilirubin level or has a risk factor for Hyperbilirubinemia, then a serum heel-stick bilirubin lab test will be done.
Hyperbilirubinemia
An abnormal increase in bilirubin is called hyperbilirubinemia. The three most common types include:
Delayed maturity of the liver which is the most common cause. This can run in families or may have occurred with a previous newborn in your family. It resolves within a couple weeks on its own. A few babies may require phototherapy.
ABO blood group incompatibility in which the mother has O blood type and the baby has A or B blood type. In this situation, the mother may make antibodies against her baby's blood cells (called DAT positive), and the antibodies can cause breakdown of the baby's blood cells (hemolysis).
Rh incompatibility - The mother has Rh negative blood and the baby has Rh positive blood. Again, the mother makes antibodies to the baby's Rh negative blood.
We tend to follow the bilirubin level more closely in ABO and Rh incompatibility with serum heel-stick bilirubin levels. In addition, a measurement of the percent of new baby blood cells, reticulocyte count, may be obtained. Bilirubin levels can be too high and require phototherapy. Some infants may need further treatment in the NICU.
The AAP, American Academy of Pediatrics, provides a nomogram (on the left) that is used to guide treatment and follow up. The majority of infants discharge from the hospital within the low intermediate risk zone (between the green and blue lines) and will follow up with their Pediatrician within 48 hours. Some bilirubin levels are in the high intermediate risk zone (between the blue and red lines). If so, infants should be seen by their Pediatrician within 24 hours and a follow up bilirubin level should be obtained.
A level in the high risk zone usually activates phototherapy, which sometimes can be done at home. As stated above, the future value on any particular day or the rate of rise cannot be predicted ahead of time; therefore, follow up with your Primary Care Provider is essential.