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Newborn and Infant Care

EXTREMLY FUSTRATED ABOUT HIS BILLIRUBIN LEVEL

04/13/1999

Question:

MY SON WAS BORN AT 35WKS WITH A BILLIRUBIN LEVEL OF 15+ AFTER ONE WK. HIS LEVEL HAD RISEN TO 21 AND THEN TO 26 ON THE 8TH DAY. HE WIEGHED 6LBS 5OZ AND WAS 6LBS 1OZ AT LEVEL 26. HE WAS IN INTENSIVE CARE FOR 2DAYS AND THE LEVEL DROPED TO 15.9, HE WAS DISCHARGED AND THE NEXT DAY IT WENT UP TO 17. THEY TELL US NOT TO WORRY, BUT MY INSTINCTS TELLS ME THAT THEY ARE TAKING THIS A BIT LIGHT. HE IS NOW 12 DAYS OLD WITH A LEVEL OF 17. HE WEIGHS 6LBS 8OZ. HE STILL EATS REALLY GOOD AND SEEMS ALEART WHEN AWAKE. DIAPER CHANGE IS AT LEAST 8TIMES A DAY, BOTH URINE AND STOOL. THEY SAY THAT THERE IS NO CHANCE FOR BRAIN DAMAGE AFTER THE 26LEVEL AND YOUR ARTICLE STATES THAT LEVELS EVEN UNDER 20 ARE DANGEROUS. WHY WOULD THEY WAIT UNTIL A PREMATURE BABY REACHES 20 BEFORE TREATING HIM. ALSO, THEY SAY THAT THE BILLIRUBIN BLANKET HAS NEVER BEEN SENT HOME WITH PARENTS,BUT THIS STORY IS SO CONFLICTING BETWEEN DIFFERENT NURSES WE HAVE SPOKE TO. AM I JUST THE OVERPROTECTIVE FATHER, OR ARE MY CONCERNS WARRENTED. THEY DID EXPLAIN THAT MY BLOOD TYPE (A+) AND THE MOTHERS (O+) IS CAUSING THE BLOOD TO ATTACK ONE ANOTHER. WHAT IS THE SPECIFIC TERM FOR THIS. THE BABIES BLOOD TYPE IS A+. THANKYOU FOR YOUR TIME AND BY THE WAY, HIS NAME IS JUSTYN AND BOY IS HE CUTE!

Answer:

Hello, "Overprotective Father"!

You have asked some very good questions about a subject that can sometimes be VERY confusing. There are many causes of "jaundice", the term used to mean the yellowish pigmentation of a baby`s skin when he/she has "hyperbilirubinemia".

Bilirubin is a yellow pigment that is normally found in the body in small amounts, generally in the red blood cell. Hyperbilirubinemia means that there is too much bilirubin in the blood. When the level of bilirubin is high in the blood, some of it leaves the circulation and gets into body tissues, causing the yellow pigmentation of the baby`s skin.

Many newborns experience jaundice because their livers are immature and can not eliminate the bilirubin as fast as it is produced. This is called "physiologic jaundice" because it is a normal process. Other factors can cause an excessive amount of bilirubin to be released, including infection, liver disease, or blood incompatability. Extremely high levels of bilirubin in the blood can be dangerous because the bilirubin can enter the brain and cause brain damage called kernicterus.

When there is an incompatability between the blood types of the mother and the baby, there can be increased destruction or hemolysis of the baby`s red blood cells, causing more bilirubin to be released. This is called an ABO incompatability and it is less severe than the Rh incompatabilty.

Now you know what is causing Justyn`s jaundice; however, this is where the information about jaundice and bilirubin levels and treatment for hyperbilirubinemia can get confusing. There is no level of bilirubin that we know causes kernicterus. The 20 level that you read about was long regarded as a guideline for treatment of hyperbilirubinemia, but that still is just a guideline. The guideline was for treatment of hyperbilirubinemia, not the level at which brain damage would occur.

Treatment for hyperbilirubinemia includes adequate fluids and calories, phototherapy, or in severe cases, exchange transfusion. The ABO incompatability does not generally cause excessively high bilirubin levels and can be conservatively managed with adequate nutrition and fluids.

Since Justyn is eating and drinking well and having sufficient numbers of stools and wet diapers, that is appropriate therapy for him. From your description of Justyn, it sounds like he is doing well.

I would encourage you to discuss this with Justyn`s pediatrician, as well as any other health concerns you may have regarding Justyn`s care.

For more information:

Go to the Newborn and Infant Care health topic, where you can:

Response by:

Judy Wright Lott, RNC, NNP, DSN
Associate Professor of Nursing
College of Nursing
University of Cincinnati