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What is bilirubin
All mothers have heard of jaundice in newborns, which is caused by an increased level of bilirubin in the blood. According to statistics, bilirubin rises in 50 percent of newborns (in premature babies, this figure is higher – up to 80 percent of children suffer from jaundice).
What is bilirubin? This is a bile pigment that is formed as a result of the breakdown of red blood cells (blood cells responsible for transporting oxygen). In a newborn child, red blood cells begin to decay, but the liver is not yet mature, there are not enough enzymes to process the decay products. Plus – additional intake of indirect bilirubin from the intestine. Therefore, in newborns, an increase in the level of bilirubin and the development of jaundice are often noted. It can be physiological, when bilirubin does not rise significantly, such jaundice goes away on its own. But in some cases, pathological jaundice may develop, which requires mandatory treatment.
What tests should be taken to check bilirubin
– The most accurate way to determine the level of bilirubin in the blood is a biochemical blood test. It is he who will be prescribed by the doctor if he suspects the development of pathological jaundice, says Anna Levadnaya, pediatrician, candidate of medical sciences, author of a blog about pediatrics. – There is also a percutaneous test – a special device that determines the approximate level of bilirubin in the blood through the skin. Such a test is the fastest, but very approximate, so it is used as an auxiliary one.
But in order to distinguish normal physiological jaundice from pathological, in addition to the indicator of the level of total bilirubin in the blood, the doctor must take into account other factors, so additional tests may be prescribed for the newborn. For example, check the level of hemoglobin and red blood cells. With physiological jaundice, these values remain normal. The level of direct and indirect bilirubin in the blood is also taken into account. In physiological jaundice, direct bilirubin is less than 20 percent.
The norm of bilirubin in newborns
“An increase in the level of bilirubin in the blood is observed in almost all newborns in the first 3-4 days of life,” says Anna Levadnaya. – In about half of full-term and almost all premature babies, this is accompanied by icteric skin staining. This is noticeable to the eye if the level of bilirubin in the blood is above about 68 µmol. With physiological jaundice in full-term children, total bilirubin is less than 256 µmol, in premature babies it is less than 171 µmol. If these numbers are higher, and there are also a number of other signs, for example, an earlier onset and prolonged increase in jaundice, dark urine and discolored stools, anemia, then additional examinations are required.
If we talk about the norm of bilirubin in the blood of a newborn (full-term), then we should focus on such indicators.
| Age of child | The level of bilirubin in the blood (μmol/L) |
| First day | to 85 |
| 36 hours | to 150 |
| 48 hours | to 180 |
| 3-5 days | to 256 |
| 6-7 day | to 145 |
| In two weeks | to 20,5 |
Elevated bilirubin in newborns
As we have already noted, an increase in the level of bilirubin to 256 μmol / l with a normal state of health of the newborn and the absence of other alarming symptoms is not dangerous. Exceeding this value indicates the development of pathological jaundice and is dangerous.
What is dangerous
– Too high an increase in the level (with “pathological” jaundice) of bilirubin in the blood can lead to brain damage, – explains Anna Viktorovna. – As a rule, this occurs in children with hemolytic disease according to the Rh factor – when there is an increased breakdown of hemoglobin due to a Rh conflict or conflict in the blood group between mother and child; also with an increase in the level of bilirubin above 298-342 µmol / l. In addition, the risk of developing bilirubin encephalopathy is increased by such conditions of the child as prematurity, brain hypoxia, anemia, intrauterine infection, taking certain antibiotics, and others.
How to bounce back
With physiological jaundice, when the level of bilirubin is slightly exceeded, the child feels well, no measures need to be taken to reduce it. The level of bilirubin gradually normalizes, as a rule, this happens by the end of the first month of life.
If we are talking about a more serious condition, when the level of bilirubin in the blood of a newborn is above 256 µmol / l, additional examinations and mandatory treatment are required.
“The modern method of reducing bilirubin is phototherapy,” says Anna Levadnaya. – Its duration and intensity depend on the birth weight of the child, as well as how much bilirubin is exceeded. In severe cases, the newborn may be given an exchange transfusion. The need for transfusion, its frequency and volume is determined by the doctor. I note that the appointment of sorbents, drugs such as phenobarbital, Essentiale, LIV-52, ultraviolet blood enrichment, electrophoresis or excessive infusion therapy with elevated bilirubin levels are ineffective, and for phenobarbital it is not safe.
Popular questions and answers
“One of the reasons for maintaining high levels of bilirubin in the blood of a newborn may be the so-called “jaundice from breast milk,” when the level of bilirubin rises because certain hormones enter the child’s body along with mother’s milk,” says Anna Levadnaya. – With such jaundice, bilirubin levels may remain elevated for longer than usual – more than 6 weeks. An accurate diagnosis can be made if, when breastfeeding is stopped for 2-3 days, the level of bilirubin begins to decrease. If the numbers are low, and the manifestation of jaundice visually decreases, then after a day or two, breastfeeding is resumed and continued. At the same time, a woman should not forget to express regularly during a pause in order to maintain lactation.
“Physiological jaundice, when bilirubin levels are not significantly exceeded, is not a contraindication to routine vaccination,” our expert explains. – Vaccination against hepatitis B cannot cause an increase in the level of bilirubin, as it affects the liver no more than any other vaccination.