Bilirubin is a yellowish compound that results from the normal breakdown of old red blood cells. This waste product is transported to the liver, processed, and then excreted primarily in stool and, to a lesser extent, in urine. When bilirubin accumulates faster than the body can eliminate it, it causes a condition known as hyperbilirubinemia. The most noticeable symptom is jaundice, characterized by the yellow discoloration of the skin and the whites of the eyes. Elevated bilirubin levels are common, particularly in newborns, but they can signal various underlying health issues in both infants and adults. Managing high bilirubin involves understanding its cause and implementing appropriate interventions.
Understanding High Bilirubin
The process of bilirubin elimination involves two primary forms: unconjugated (indirect) and conjugated (direct) bilirubin. Unconjugated bilirubin is produced initially when red blood cells break down, and it is not water-soluble. It must be carried by a protein called albumin to the liver, where it is chemically changed, or conjugated, into a water-soluble form. The conjugated bilirubin is then excreted via the bile ducts into the small intestine for final removal from the body.
Elevated levels of bilirubin can occur due to problems at any stage of this process, but the cause differs significantly between newborns and adults. Newborn hyperbilirubinemia is common because the infant’s liver is still immature and less efficient at conjugating bilirubin in the first few days of life. This transient elevation is known as physiological jaundice and typically resolves on its own.
Other common neonatal causes include breastfeeding jaundice, related to low milk intake or dehydration, leading to decreased excretion. Breast milk jaundice appears later and can persist for several weeks. In adults, high bilirubin usually indicates a serious underlying disorder, such as increased red blood cell destruction (hemolysis), liver diseases like hepatitis or cirrhosis, or a blockage in the bile ducts, often from gallstones or tumors. The specific form of bilirubin that is high helps medical professionals pinpoint the location of the problem.
Supportive Care for Mild Jaundice
For mild jaundice, especially the common physiological type seen in newborns, supportive care focuses on maximizing the body’s natural ability to excrete bilirubin. The most effective at-home strategy is ensuring the infant receives frequent and adequate nutrition. Frequent feeding stimulates the bowels, which increases the number of stools passed. Since bilirubin is primarily eliminated through the stool, more frequent bowel movements help flush the excess compound from the body.
For breastfed infants, this typically means feeding 8 to 12 times in a 24-hour period during the first week. For formula-fed infants, a consistent schedule of 1 to 2 ounces every two to three hours is recommended to promote hydration and gut motility. Adequate hydration is important because dehydration can increase bilirubin concentration in the blood.
Some parents may be advised to expose the infant to indirect sunlight, as light can help break down bilirubin in the skin. However, this must be done with caution, ensuring the baby is never exposed to direct sun, which can cause severe sunburn or overheating. These supportive measures are appropriate only for mild cases and must be monitored by a healthcare professional.
Clinical Treatments for Severe Jaundice
When bilirubin levels are dangerously high or rising rapidly, particularly in newborns, medical interventions are necessary to prevent potential brain damage. The most common and effective treatment is phototherapy, which involves placing the infant under special blue-green lights. This light penetrates the skin and converts the water-insoluble unconjugated bilirubin molecules into water-soluble isomers. These new isomers can then be excreted directly in the bile and urine, bypassing the bottleneck of the immature liver.
Phototherapy is a non-invasive treatment that requires the baby to be naked, wearing only a diaper and protective eye shields, to maximize skin exposure. The light source can be a traditional overhead lamp, a fiber-optic blanket, or a pad placed beneath the infant.
For extremely high or rapidly rising bilirubin levels that do not respond to phototherapy, a procedure called an exchange transfusion may be performed. This involves slowly removing small amounts of the infant’s blood and replacing it with donor blood, which rapidly reduces the total circulating bilirubin.
In adults, treatment for hyperbilirubinemia focuses on resolving the underlying cause rather than directly breaking down the bilirubin. If the cause is pre-hepatic (excessive red blood cell destruction), managing the hemolytic condition is the focus. If the cause is hepatic (involving the liver), treatment may involve medications to manage inflammation or address the underlying disease. For post-hepatic causes, such as a blocked bile duct, surgical or endoscopic procedures may be required to relieve the obstruction.
Recognizing Signs of Danger and Urgent Care
Recognizing signs that high bilirubin is escalating to a dangerous level is a matter of urgent concern, especially in infants. Unconjugated bilirubin is neurotoxic and can cross the blood-brain barrier, potentially leading to a serious condition called kernicterus.
Warning Signs in Newborns
Warning signs in a newborn include lethargy, difficulty waking, poor feeding, or an intense, high-pitched cry. Physical symptoms can progress to arching of the back, body stiffness, or a fever. Jaundice that spreads quickly below the knees or appears within the first 24 hours of life also warrants immediate medical evaluation.
Warning Signs in Adults
In adults, high bilirubin signals a potentially life-threatening underlying disease. Accompanying symptoms that require urgent care include severe abdominal pain, sudden mental confusion, or persistent vomiting. Symptoms of complete obstruction, such as dark urine and pale, clay-colored stools, also require immediate attention. Any sudden, noticeable worsening of jaundice or the onset of these associated symptoms should prompt an immediate visit to a healthcare provider.