Hyperbilirubinemia Definition
Hyperbilirubinemia is caused when too much bilirubin, a substance formed when red blood cells break down, is found in the blood. Babies are not able to get rid of the bilirubin, so it builds up in blood and tissues. Jaundice often accompanies hyperbilirubinemia. The pigment of bilirubin causes the baby's skin and the whites of the eyes to become yellow, resulting in jaundice. Jaundice can happen at birth or later, depending on the cause of the hyperbilirubinemia. Cornell University states that 60 percent of full-term babies and 80 percent of premature babies will experience jaundice, and that babies born to diabetic mothers or those with Rh disease are more likely to have hyperbilirubinemia and jaundice.
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Causes
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A baby's own liver has to take over processing bilirubin for elimination through stool after birth. Sometimes this takes a little while, so the infant has hyperbilirubinemia until the body is able to handle removing it. This form of the condition, called physiological jaundice, usually clears up within two weeks.
Breast milk jaundice is caused by a substance present in the milk that increases reuse of bilirubin by the intestines. Babies with this type of jaundice usually show signs after day 7 of breastfeeding, with the condition clearing completely after a month or so.
Underlying Medical Conditions
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Underlying medical conditions can cause hyperbilirubinemia in some infants. Some conditions that can cause the problem are congenital spherocytic anemia, elliptocytosis, blood type incompatibilities, injury during birth, infection and transfusion. Alpha-1 antitrypsin deficiency, some medications, congenital hypothyroidism, rubella and syphilis among other congenital conditions. Hypoxia and neonatal hepatitis are other conditions that can cause jaundice and hyperbilirubinemia.
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Considerations
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Most cases of hyperbilirubinemia cause no concern, but if high enough concentrations of bilirubin accumulate in the tissues of the brain, seizures may occur. This can lead to brain damage or a condition called kernicterus.
Symptoms
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The most common symptoms associated with hyperbilirubinemia are yellowing of the skin that begins on the face and moves downward over the body, lethargy and poor feeding habits.
Risk Factors
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Healthy, full-term babies who are more likely to develop hyperbilirubinemia and newborn jaundice have a sibling who needed phototherapy for jaundice, have high bilirubin levels, are only breastfeed and may be overweight, have a red blood cell disease or blood group incompatibility, significant bruising, are of Asian descent or have jaundice during the first 24 hours of life.
Treatment
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Treatment for hyperbilirubinemia and jaundice includes phototherapy, in which the baby is exposed to special blue spectrum lights to decrease levels of bilirubin. Sometimes, a fiber optic blanket is placed under the baby as an added phototherapy technique. Exchange transfusion, in which the baby's blood is replaced with new, undamaged blood, is used. Stopping breastfeeding is required if breastfeeding jaundice is to blame.
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