Hyperbilirubinemia and Newborns
Hyperbilirubinemia occurs when elevated levels of bilirubin are caused by either increased bilirubin production, or decreased bilirubin metabolism or excretion. Neurological dysfunction can result from extreme bilirubin levels. Damage is usually seen in the basal ganglia, central and peripheral neurologic pathways, hippocampus, brain stem nuclei and the cerebellum. The damage can range from mild to severe. Kernicterus is chronic irreversible brain damage that is caused by extremely high levels of bilirubin. Fortunately, kernicterus is a completely preventable event when proper newborn care is provided.
The American Academy of Pediatrics recommends that all newborns have either a formal risk assessment preformed, or a bilirubin level obtained prior to the baby leaving the hospital. Should there be any concerns about an infant's bilirubin levels, often a lactation consultant will be asked to help evaluate an infant's breastfeeding during the first few days of life. The three common causes of indirect hyperbilirubinemia in newborns are physiologic jaundice, breastfeeding associated jaundice and breast-milk jaundice.
Physiologic jaundice usually occurs within 48 to 72 hours or life and peaks between day three to five. The cause is due to red blood cell breakdown which can cause the infant to have normal weight loss, normal output and still be able to thrive. It is important to ensure that the baby is monitored to ensure effective breastfeeding and normal weight gain.
Breastfeeding associated jaundice can occur within 48 to 72 hours and peaks from three to five or more days. The cause is usually due to starvation or a delay in defecation. The infant may appear lethargic or fussy; may have excessive weight loss; ineffective feeding; poor urine/stool output; or signs of dehydration. It is important to help the infant increase his/her caloric intake by helping the mother to establish effective breastfeeding or by stimulating or supplementing the milk supply.
Breast-milk jaundice occurs around five to ten days old and peaks around 15 days old. The cause is still unknown but the child is still considered thriving even though he/she may be considered clinically jaundiced. No breastfeeding intervention is needed but a physician will likely monitor the bilirubin until it is stable.