What is hyperbilirubinemia in a newborn?

Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.

Bilirubin is made by the breakdown of red blood cells. It’s hard for babies to get rid of bilirubin at first. It can build up in their blood, tissues, and fluids.

Bilirubin has a color. It makes a baby’s skin, eyes, and other tissues turn yellow (jaundice). Jaundice may first appear when your baby is born. Or it may also show up any time after birth.

What causes hyperbilirubinemia in a newborn?

During pregnancy, the placenta removes bilirubin from your baby’s blood. When a baby is born, the baby's liver takes over this job. Your baby may have too much bilirubin for many reasons.

Which newborns are at risk for hyperbilirubinemia?

About 3 in 50 full-term newborns become jaundiced. So do 4 in 5 premature babies. Babies born to a birth parent with diabetes or Rh disease are more likely to have this condition. Babies who underwent a difficult birthing process that resulted in significant bruising or bleeding under the scalp are also at risk for hyperbilirubinemia.

What are the symptoms of hyperbilirubinemia in a newborn?

Symptoms can occur a bit differently in each child. They can include:

• Yellowing of your baby’s skin and the whites of their eyes. This often starts on a baby’s face and moves down their body.

• Poor feeding

• Lack of energy

The symptoms of this health problem may be similar to symptoms of other conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is hyperbilirubinemia in a newborn diagnosed?

The timing of when your child’s jaundice first starts matters. It may help their healthcare provider make a diagnosis.

• First 24 hours. This type of jaundice is often serious. Your child will likely need treatment right away.

• Second or third day.  This is often physiologic jaundice. Sometimes it can be a more serious type of jaundice. It's important to be sure the baby is getting enough milk at this point.

• Toward the end of the first week. This type of jaundice may be from breastmilk jaundice but may be due to an infection or other rare, serious problems.

• In the second week. This is often caused by breastmilk jaundice but may be caused by rare liver problems.

Your child’s healthcare provider may do these tests to confirm the diagnosis:

• Direct and indirect bilirubin levels. These levels show if bilirubin is bound with other substances by your child’s liver. Normal physiologic jaundice has indirect bilirubin. Jaundice due to more serious problems can have high levels of either type of bilirubin.

• Red blood cell counts

• Blood type and testing for Rh incompatibility (Coombs test)

How is hyperbilirubinemia in a newborn treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

What are possible complications of hyperbilirubinemia in a newborn?

High levels of bilirubin can travel to your baby’s brain. This can cause seizures and brain damage. This is called kernicterus.

What can I do to prevent hyperbilirubinemia in my newborn?

This condition can’t really be prevented except in the case of suboptimal intake jaundice. Feedings should start within the first hour of life and continue at least every 2 or 3 hours, or sooner if the baby shows signs of wanting to eat. The more premature the baby, the more likely they are to need supplements of expressed milk or formula at first. For all babies, diagnosing jaundice early and getting treatment right away are key. This can stop your baby’s bilirubin levels from rising to dangerous levels.

Key points about hyperbilirubinemia in the newborn

• Hyperbilirubinemia happens when there is too much bilirubin in your baby’s blood.

• About 3 in 5 full-term newborns and 4 in 5 premature babies become jaundiced.

• The most common symptom is yellowing of your baby’s skin and the whites of their eyes.

• The timing of when your child’s jaundice first starts matters. It can help their healthcare provider make a diagnosis.

• Make sure you feed your baby early and often.

• Diagnosing jaundice early and getting treatment right away are key. This can stop your child’s bilirubin from rising to dangerous levels.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• The name of the test or procedure

• The reason your child is having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• When and where your child is to have the test or procedure

• Who will do the procedure and what that person’s qualifications are

• What would happen if your child did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or your child has problems

• How much you will have to pay for the test or procedure