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Hyperbilirubinemia - Medical Malpractice
All newborns have a likelihood of getting some rise in their bilirubin after birth. This is because infants are born with more blood in their system than they really need and the body begins to break down the blood products. The final product of blood metabolism is bilirubin. Excesses of bilirubin make the baby yellow, which is not dangerous in and of itself unless it grows to a high proportion. It is the responsibility of the liver to break down the blood products but, because the liver is immature, it can't keep up with the load of blood trying to break down and the result is neonatal hyperbilirubinemia. If the rise in bilirubin is severe, the end result is kernicterus, which is a condition in which the brain is affected by the severe bilirubin levels.
Normal levels of neonatal bilirubin include levels under five mg/dL. It is called neonatal hyperbilirubinemia any time the bilirubin is above 5 mg/dL. Up to sixty percent of all infants have some degree of neonatal hyperbilirubinemia and appear jaundiced in their eyes or skin at the time of birth. It usually goes away by one week of life. The infant behaves normally and the infant's disease runs its course. In certain situations, there is more blood than the liver is able to handle and the infant gets a more severe case of the disease or the disease progresses to kernicterus.
Unfortunately, there can be severe illnesses related to neonatal hyperbilirubinemia, including haemolytic diseases of the newborn, liver disorders, metabolic disorders and endocrine disorders. Any infection of the liver results in neonatal hyperbilirubinemia in many cases.
In most cases, the bilirubin stays below 12 mg/dL and the condition is treatable using light therapy. Risk factors for minor disease include having Rh incompatibility and ABO incompatibility. If the baby has a large cephalhematoma or blood clot under the skin of the scalp, there can be extra blood the baby needs to get rid of and this can cause mild to moderate hyperbilirubinemia. Other kinds of bruising can contribute to excess blood in the body the baby needs to metabolize. If the mother took Valium or there was pitocin used in labour, the infant can get excess bilirubin production. If a baby is premature or had a sibling with neonatal hyperbilirubinemia, there can be an increased risk for the disease.
Kernicterus is when the brain is affected by severe neonatal hyperbilirubinemia. Unconjugated bilirubin travels across the blood brain barrier and causes bad brain disease. The bilirubin is lipid-soluble and is carried across the blood brain barrier by albumin. If the level of bilirubin is greater than 25 mg/dL, the chances of getting kernicterus are very elevated. Kernicterus is, unfortunately, irreversible and can cause a condition known as bilirubin encephalopathy. Babies with bilirubin encephalopathy include developmental delay, motor delays, mild mental retardation and deafness of the infant.
Signs and symptoms of kernicterus include lethargy, poor muscle tone, a high pitched cry and poor feeding. As the disease progresses, the baby can have abnormal posture, fever, changes in the eyes and seizures.
Doctors check for hyperbilirubinemia by checking a serum unconjugated bilirubin level. If the bilirubin level is at a level of 4 mg/dL or less, you cannot see a yellowing of the skin. Jaundice begins at the head and ends up at the feet and hands, at the soles of the feet and the palms of the hands. If it reaches the palms of the hands, the level is about fifteen mg/dL. If the jaundice is physiological and at a low number, the baby is watched, kept in the sunshine and hydrated well. If the neonatal hyperbilirubinemia is pathological, it is treated with light therapy so as to help lower the bilirubin level. Pathologic neonatal hyperbilirubinemia is associated with petechiae beneath the skin, excessive bruising, an enlarged spleen or an enlarged liver. The infant will have lost weight and be dehydrated.
Phototherapy is the best therapy for mild, moderate or slightly severe cases of neonatal hyperbilirubinemia. Chambers flood the infant skin with light and reduce the unconjugated bilirubin to conjugated bilirubin at a level of about 1-2 mg/dL for every four to six hours under the lights. It is harder to bring down the bilirubin with breastfed infants as they don't get a lot of liquid right away. In cases where the bilirubin is very high, doctors do exchange transfusions, exchanging blood containing high bilirubin with blood containing low bilirubin. This is the fastest way to bring down bilirubin in cases of possible kernicterus or pre-kernicterus.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here