If a newborn's bilirubin level reaches 20 mg/dL, it's a serious concern, especially after the first 72 hours. Here's why:
Understanding the Implications of High Bilirubin
Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. Normally, the liver processes bilirubin, making it water-soluble so it can be excreted. However, newborns often have immature livers that can't process bilirubin quickly enough, leading to a buildup in the blood (hyperbilirubinemia).
Why Bilirubin Levels Matter
When bilirubin levels get too high, particularly unconjugated bilirubin, it can cause problems. Unconjugated bilirubin is not water-soluble and needs to bind to albumin in the blood to be transported to the liver.
According to health guidelines, intervention is generally recommended for newborns when:
- Bilirubin levels exceed 15 mg/dL in the first 48 hours.
- Bilirubin levels rise above 20 mg/dL after 72 hours. This is because, at these levels, unconjugated bilirubin exceeds the amount of available albumin to bind it (Reference).
Risks Associated with Bilirubin of 20
When unconjugated bilirubin is not bound to albumin and remains free in the bloodstream, there is a risk of it crossing the blood-brain barrier. This can lead to a rare but serious condition called kernicterus. Kernicterus can cause brain damage, leading to developmental delays, hearing loss, movement problems, and even death.
Treatment Options
The primary goal of treatment is to lower bilirubin levels quickly and safely. Common treatments include:
- Phototherapy: This involves exposing the baby's skin to special blue lights, which help convert unconjugated bilirubin into a form that can be excreted in the urine and stool.
- Exchange Transfusion: In severe cases, where bilirubin levels are dangerously high or phototherapy is not effective, an exchange transfusion may be necessary. This involves slowly removing the baby's blood and replacing it with donor blood, which lowers bilirubin levels and removes antibodies that may be contributing to the problem.
What to Do
If your baby's bilirubin level is 20 mg/dL or higher, it's crucial to:
- Contact your pediatrician or a healthcare professional immediately.
- Follow their recommendations for treatment and monitoring.
- Ensure your baby is feeding well to promote bilirubin excretion through stool.
