Jaundice In Newborn (Neonatal Hyperbilirubinemia)

Neonatal Hyperbilirubinemia or jaundice in newborn is characterized by the presence of excess amounts of bilirubin in the blood, resulting from the breakdown of red blood cells.

  • Hyperbilirubinemia in infants is often the result of feeding problems encountered in newborns, as well as the breakdown of large amounts of red blood cells. Infection of the blood, termed sepsis, also may cause this condition.
  • Typical symptoms of jaundice, such as the yellowing of the skin and the white part of the eyes, are caused by excess of bilirubin in the blood.
  • The symptoms of jaundice indicate hyperbilirubinemia which is confirmed by the bilirubin levels measured by a blood test.
  • Infants discharged within a day of birth need to have their blood levels of bilirubin checked by a medical professional at home, or at their doctor’s office, at least once within the next week.
  • Phototherapy is used to treat infants with jaundice. Exchange blood transfusion may be necessary in some cases when the blood levels of bilirubin are very high.

When red blood cells in the blood age, they are destroyed in the spleen, and the oxygen carrying compound hemoglobin from the broken down WBCs is recycled. The yellow-colored bilirubin is produced from the heme part in the hemoglobin. When blood reaches the liver, it alters the bilirubin chemically, and incorporates it into bile, which is then poured into the intestines with other digestive secretions. The bilirubin gets eliminated from the body through bowel movements.

An increase in the bilirubin levels in the newborn’s blood is usual in the first few days following birth, but it is considered to be normal. The presence of excess bilirubin in the blood may cause yellowing of the skin, which is called jaundice. The whites of the eyes also may take on a yellowish color. If the infants are not fed well soon after birth, due to illnesses, or disorders of the digestive system, the bilirubin does not get eliminated from the body through bowel movements. It results in the elevation of bilirubin levels in the blood. Breastfeeding infants usually have higher levels of bilirubin in the blood in the first week after birth, but it does not affect them adversely. Eventually, as the breastfeeding improves, the blood levels of bilirubin become normal, as frequent feedings leads to more frequent bowel movements through which the bilirubin is eliminated.

When infants have other serious disorders such as infections or sepsis, it may result in severe neonatal hyperbilirubinemia. Blood group incompatibility (ABO incompatibility, Rh incompatibility) is another significant cause of hyperbilirubinemia as the consequent hemolysis or rapid destruction of red blood cells causes abnormally high levels of bilirubin in the blood.

Moderate to moderately high levels of bilirubin does not cause any serious problems in the infant and it usually resolves on its own or with phototherapy. However, very high levels can lead to brain damage in the infants. Kernicterus is the term used to refer to brain damage resulting from severe hyperbilirubinemia. Extremely premature babies, and those with serious illnesses at birth, are more prone to developing this condition. Intensive treatment helps avoid kernicterus in susceptible infants. Breastfeeding infants who are premature by only a few weeks, and infants discharged within one or two days of birth, should be carefully monitored for signs of jaundice in the following one week or two, as they are at risk of developing kernicterus if their blood levels of bilirubin become elevated unnoticed. Slightly premature babies may not be able to feed as well as babies born at term, which makes them more prone to developing hyperbilirubinemia. Another reason is that the milk production in the mother may be limited in the first few weeks when the baby is born early, and insufficient feedings result in fewer bowel movements.

Symptoms and Diagnosis

Neonatal hyperbilirubinemia is easier to spot in light-skinned infants, as the discoloration usually starts appearing on the face of the infant, and progresses towards the chest and abdomen with the increase in the blood levels of bilirubin, finally reaching the feet. The whites of the eye also may be discolored. But the presence of jaundice alone cannot determine the severity of hyperbilirubinemia. A blood test helps determine the exact amount of bilirubin in the infant’s blood. Very high levels of bilirubin may lead to kernicterus.

Kernicterus has symptoms which include poor feeding and extreme lethargy in the infants. When babies who already have jaundice develop the symptoms characteristic of kernicterus, immediate medical attention should be sought. As kernicterus progresses, more symptoms such as stiffening of muscles, irritability, and arching of the back, may develop. Seizures also may occur. These symptoms may be accompanied by fever too.

All the infants should be monitored for signs of jaundice in the first few days of life. When it is detected, tests should be performed to determine the blood bilirubin levels. In many hospitals, bilirubin levels are routinely checked before the infant is discharged. Sometimes, the jaundice may be very mild in the beginning, but it increases several days after discharge. In such cases the infants should be either checked by a doctor or a qualified medical professional visiting at home, or they should be brought in for a post natal assessment. If the infant is discharged within one day of birth also, it is essential to visit the doctor at least once within the next week. Careful monitoring and testing for bilirubin levels is very important for breastfeeding infants who are born prematurely.

After examining the infants under bright light, the bilirubin level is checked using an equipment called transcutaneous bilirubinometer, which is held close to the infant’s skin. A more accurate method is testing a blood sample taken from the infant.


When Neonatal hyperbilirubinemia is mild, it need not be treated. Frequent feedings increase bowel movements through which most of the bilirubin can be excreted, lowering its levels in the blood. When the contents of the intestines remain longer in the body, bilirubin is reabsorbed. Breastfed babies have to be fed as often as possible as they tend to develop jaundice due to poor feeding.

When hyperbilirubinemia is moderate, the infants are treated by phototherapy. Infant’s entire body is exposed to special white or blue lights called bilirubin lights. The light changes bilirubin into another compound which is easily removed by the liver and excreted by the kidneys. To avoid damage to the eyes by the lights, a blindfold is placed over the infant’s eyes. A special fiber-optic blanket which emits bilirubin lights can be used to cover the infant at home. Infants undergoing phototherapy should be tested frequently to ensure that the bilirubin level in the blood is decreasing. There is a possibility that bilirubin levels may remain high even when the outward symptoms of jaundice have disappeared.

Occasionally, mothers are asked to stop breast feeding the infant for one or two days, and to give formula feed instead. Unlike in breastfeeding, it is possible to check the amount of bottle feed the infant is receiving, so that inadequate feeding, if present, can be detected. Once the bilirubin levels start showing a decreasing trend, then breastfeeding can be resumed.

Moderate cases of neonatal hyperbilirubinemia usually respond to phototherapy and get resolved in a few days. But if bilirubin levels do not come down with phototherapy, or when the levels are dangerously high, an exchange blood transfusion can be done for the rapid lowering of bilirubin levels. The transfusion takes place through the infant’s umbilical vein. A catheter is inserted into the vein in the umbilical cord stump and blood is drawn out with the help of a syringe. After the removal of one syringe of jaundiced blood, fresh, healthy blood from the blood bank is injected into the vein in equal amounts. The exchange transfusion helps keep the bilirubin levels low.

Watch This Video Explaining Jaundice in Newborns:

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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