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Newborn and Infant Care

Normal bilirubin levels in newborns

08/30/2007

Question:

my 3 day old grandson is somewhat jaundiced.

his bilirubin level is 12.1 yesterday it was 12.3. Can you please tell me what the normal or safe level of bilirubin is?

Answer:

Whether or not a bilirubin level is considered normal or not depends on how many hours old the baby is, whether or not the baby was born early or on-time, and whether the baby is sick or well. In general, babies born early and those who are ill have treatment for lower bilirubin levels than do full term babies because no one knows what a "safe" bilirubin level is for a preterm or ill infant. Also, if the baby's bilirubin rises quickly in the first 24-48 hours of life, it is more likely due to a problematic red cell destruction process that requires early treatment, for example, if the mother and the baby's blood types do not match.

For healthy, full term babies 72 hours of age, doctors expect to see a bilirubin level under if all is going well with feeding and there is no excessive destruction of red blood cells. Jaundice or yellowness is the result of a normal process of red cell destruction that all babies have. Before birth, the baby's body makes a large number of red blood cells with specialized fetal hemoglobin to carry all of the oxygen possible from the mother's placenta to the baby to fuel good growth. However, after birth, the baby no longer needs this high number of red blood cells or the specialized hemoglobin, so the baby's body gets rid of some of these red cells.

The discarded red blood cells go to the baby's liver for processing and the bilirubin part of the red blood cell goes into the bile and then into the baby's stool and out into the diaper. However, because the new baby's liver is not functioning at full ability and the baby is not eating large amounts of food to produce a lot of stool, the bilirubin level increases and causes the skin and white of the baby's eyes to appear yellow.

This normal type of jaundice peaks between 3 and 5 days of age. Even though this is an expected red blood cell destruction process, levels of 15 and above can lead to problems with hearing and development, so they need to be treated with phototherapy, either at home or in the hospital, depending on how high it is and the resources available in the family's community.

Jaundice due to unhealthy disease processes peaks in the first 1-2 days of life. These babies must stay in the hospital for treatment. There is also a type of jaundice that peaks after 7-10 days of age and lasts a long time that occurs in breastfed babies. This type of jaundice called breastmilk jaundice is not well understood but has not been known to cause problems for the baby.

Based on the timing of the jaundice's appearance in your grandson, it seems likely that it is the expected newborn jaundice. His doctor will make sure he is eating well to aid the process of getting rid of the bilirubin in his stool and that the level is beginning to decline. Should it continue to rise, he or she will likely order phototherapy treatment.

I hope this information is helpful. Congratulations on your new grandchild! Enjoy him!

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University