Bilirubin Information

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Bilirubin

A by-product of the breakdown of red bloods. which normally circulate in the bloodstream forbout four months until they literally wear out. 'The liverpocesses and excretes bilirubin. If the liver is diseased,in hepatitis, or immature, as in newborns, the level ofeirubin in the bloodstream may become high enoughcause a yellow-orange discoloration of the skinMown as jaundice.

Before birth a baby's bilirubin is largely managedbough the mother's circulation. After birth it takes airwborn's liver a few days to take over this process, sobe level of bilirubin in the baby's bloodstream will in-nate by a modest amount. If a significant backlog de-clops, the baby's skin will take on a yellow-orange hue,Neginning with the head and gradually spreading towardme legs. Whether or not jaundice is significant will de-end upon several factors, including the actual level ofalirubin, how soon and how fast it has risen, the sus-rected cause, and whether the baby is full-term or pre-nature. In some instances, extremely high bilirubinreels can damage the central nervous system, especiallyn the premature infant. If you notice your new baby'skin color changing to bright yellow-orange, contactour baby's doctor.

If there is any concern, the baby's physician will order food tests to check the bilirubin level, and if needed,rther studies will be done to look for underlying causes.kmetimes high levels of bilirubin result from a differ-nee between a mother's blood type and that of her new-born. For example, if the mother's blood type is 0 andthe baby's is A or B, some anti-A or anti-B antibodiesfrom the mother may cross the placenta into the baby'scirculation before birth. These antibodies can destroy'any of the newborn's red cells, leading to a high biliru-in level shortly after birth.

A more severe form of this process used to occurommonly in connection with a protein known as theRh factor, which is either present on the surface ofblood cells (making a pers. Rh-positive) or absentRh-negative). Whenever a mother with Rh-negativeblood gave birth to an infant who was Rh-positive, themother's immune system could become sensitized tothe Rh factor. If she had another pregnancy with an Rh-positive baby, her Rh antibodies would cross the pla-centa and destroy significant numbers of the new baby's

red cells. Babies born under these conditions were oftenjaundiced at birth and became quite ill, requiring im-mediate transfusions of antibody-free blood. Today Rhincompatibility problems are avoided by giving Rh-nega-tive mothers a shot (called RhoGam) that prevents herimmune system from developing Rh antibodies.In most cases, a newborn's jaundice is the by-productof normal physiological processes and is not caused byan Rh or blood type incompatibility or other problems(such as infection). This so-called physiologic jaundicewill eventually resolve on its own within 10 to 14 days.In some situations (depending on various factors),the baby's doctor will recommend one or more of thefollowing measures to help lower a bilirubin level thathas become significantly elevated:

•Treat any underlying cause (such as an infection),if present.

•Increase the baby's fluid intake by feeding hermore often.

•Expose the baby to indirect sunlight for periods of20 to 30 minutes - dressed only in a diaper in asunlit room where the sun does not shine directly onher sensitive skin. Since indirect sunlight has only amodest effect on clearing bilirubin, don't use thisapproach unless you are sure that your baby won'tbecome too hot or too cold.

•Sometimes an enzyme found in the mother's milkinterferes to a modest degree with the clearing ofbilirubin. Your physician may ask you to stopbreast feeding for a short time and use formulauntil the problem improves, after which nursingcan resume. In such a case, it is important that youcontinue to express milk to maintain your supply.This should not be an occasion to stop nursingaltogether. Some healthy breast-fed infants willhave a slight orange hue for weeks.

•A treatment called phototherapy may be utilizedif the bilirubin level needs to be treated. Under aphysician's direction, the baby lies under a specialintense blue light while wearing eyeshades like asunbather at the beach. In addition, or as an alter-native, a baby can lie on a thin plastic light sourcecalled a Bill Blanket. Whether carried out in ahospital or at home (using equipment provided bya home-health agency), phototherapy usuallyreduces bilirubin gradually within two or threedays, if not sooner.

A newborn whose jaundice resolves and then re-appears should be checked by a physician, as should anolder infant or child who appears jaundiced for the firsttime. Some older infants who are taking solids and regularly enjoy carrots and other yellow vegetables may ac-tually develop a slight orange hue, which is harmless andhas nothing to do with bilirubin. This does not cause thewhites of the eyes to become yellow. A more obvious yel-low coloration of skin (as well as the whites of the eyes)in a child may indicate that the liver is inflamed or (farless commonly) that the drainage of bile from the liver isobstructed.

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