NEONATAL-HYPERBILIRUBINEMIA

NEONATAL HYPERBILIRUBINEMIA

Neonatal Hyperbilirubinemia is a condition that means an elevated serum bilirubin concentration, causes jaundice, a condition that is characterized by a yellow discoloration of the skin and eyes. The serum bilirubin level that can cause jaundice varies directly with skin tone and body region. 

However, jaundice becomes typically noticeable on the sclera at a level of 2 to 3 mg/dL or 34 to 51 mmol/L and on the face at about 4 to 5 mg/dL or 68 to 86 mmol/L respectively. With growing bilirubin levels, jaundice might start to show from the head-to-foot direction, recognizing it at the umbilicus at about 15 mg/dL (258 mmol/L) and the feet at about 20 mg/dL (340 mmol/L). Furthermore, in some infants, serum bilirubin levels might increase excessively, which can be considered alarming because unconjugated bilirubin is neurotoxic and can be fatal in newborns and lifetime neurologic sequelae in infants who luckily survived.

Moreover, an infant whose blood type isn’t compatible with that of their mother can develop a gradual increase of antibodies that can wreck their red blood cells and cause a sudden rise in bilirubin levels.

Thus, this article swirls around the facts about neonatal hyperbilirubinemia and will help the readers understand how the causes, types, diagnosis, and treatments work.

TYPES

Below are the reported types of neonatal hyperbilirubinemia. 

  • Physiological Jaundice

The most abundant type of newborn hyperbilirubinemia has no severe effects. It includes neurodevelopmental abnormalities such as athetosis, loss of hearing, and intellectual deficits, caused by the high toxic levels of bilirubin.

  • Pathological Jaundice

Bilirubin levels with a deviation from the normal range and have required intervention. Also, jaundice appears for 24 hours due to an increase in serum bilirubin beyond 5 mg/dl/day, peak levels higher than the expected normal range, and dark urine. 

  • Breastfeeding and Breast Milk Jaundice

Hyperbilirubinemia is also connected to the breast milk of mothers in neonates. About 2% to 4% of exclusively breastfed babies have jaundice over 10 mg/dl in the third week of life.

  • Nuclear jaundice

Vast amounts of bilirubin uncommonly gather in the blood and cause cerebral lesions that include hearing loss, mental retardation, and behavioral disorders.

  • Rh Factor Hemolytic Disease

This newborn’s disease (RHDN) results from maternal red-cell alloimmunization.

  • ABO Incompatibility

The result of the incompatibility of an ABO blood group of the biological mother and fetus. ABO Incompatibility is 15–20% of all pregnancies, when the mother has the blood type O, and the newborn has the blood type A or B.

  • Jaundice Associated With G6PD Deficiency

Hereditary spherocytosis and minor group incompatibilities must be similarly managed with ABO incompatibility.

SYMPTOMS

  • Yellowing of skin and eyes usually begins within 2-4 days from the face and spreads down across the body.
  • Bilirubin levels usually peak between 3-7 days after birth.
  • If pressing lightly on an infant’s skin will show color yellow, it can be jaundice.
  • The infant develops a fever over 100°F (38°C).
  • Eats poorly, appears lethargic, and makes high-pitched cries.

DIAGNOSIS

  • A distinct yellow coloring needs additional tests to determine the severity of jaundice.
  • Bilirubin levels are measured immediately, either through a skin test or blood test.
  • The complete blood count (CBC), blood type, and Rhesus factor (Rh)  will be a test factor for incompatibility.
  • To check for increased red blood cell breakdown, Coombs test will be performed.

TREATMENT

  • Mild jaundice will normally resolve on its own as the infant’s liver begins to mature. 
  • Food intake at about 8 -12 times a day will help the infant to pass bilirubin through their bodies.
  • Severe jaundice may require other treatments such as phototherapy, a standard and highly effective treatment method that uses light to break down bilirubin in the infant’s body.
  • In very severe cases, an exchange transfusion is necessary for an infant to receive little blood from a donor or a blood bank.

Neonatal hyperbilirubinemia is a common disorder in infants that can be fatal if left untreated. Symptoms and several types have been discussed, which varies depending on the level of bilirubin present in infants. Thus, there is no specific way to prevent jaundice. However, a proper diagnosis must be encouraged if symptoms were being noticed. Finding suitable treatments for each particular case shall come forth.

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