A Parent's Guide to the NICU

Jaundice/Hyperbilirubinemia

What are jaundice and hyperbilirubinemia?

"Hyper" means high; "emia" means in the blood. Hyperbilirubinemia is a high level of bilirubin in the blood.

Jaundice is the yellow color to the skin that is often seen in the first few days after birth. The yellow color is due to bilirubin.

What is bilirubin?

Bilirubin is produced when red blood cells get old and are broken down by the body. Normally it is processed in the liver and then deposited in the intestine so it can come out in the stool.

Why do babies have jaundice?

The red blood cells of babies have shorter lives than adult red blood cells; bruising at birth may cause a larger number of red cells to be broken down. All of the bilirubin from these cells needs to be processed by the baby's liver.

Premature babies do not have fully developed organs. Their livers cannot process bilirubin rapidly. Their intestines may not move much in the first few days especially if they are sick and not being fed.

Is bilirubin bad?

Small or moderate increases in bilirubin are not harmful. Extremely high levels of bilirubin can be harmful, causing brain damage. Your baby's bilirubin will be measured if s/he becomes jaundiced to be sure that s/he does not come close to having harmful levels.

How is jaundice treated?

If the level of bilirubin is high enough to need treatment, it is usually treated with phototherapy. This means the undressed baby is placed under special lights or, the baby can be placed on a light producing blanket. The light helps break down the bilirubin in the skin. It may cause the baby to have runny stools.

Why are babies' eyes covered when they are having phototherapy?

It may not be good for babies to have bright light continuously shining in their eyes. The eyes are covered to protect them from so much light.

How long will my baby have jaundice?

The duration of jaundice varies greatly from baby to baby. Bilirubin levels increase over the first several days and then fall slowly. Phototherapy is usually needed for a few days, but occasionally for more than a week. Babies receiving breast milk may remain yellow longer than those receiving formula, but usually these low levels are not harmful.

What happens if a baby's bilirubin rises close to dangerous levels?

It is very uncommon for premature infants to need any treatment other than phototherapy. However, if a baby's bilirubin gets close to harmful levels, the doctor can do an exchange transfusion, a procedure where the baby's blood containing the bilirubin is replaced with blood from the blood bank. Also, this can be done if a baby's mother has made antibodies against the baby's blood and the antibodies are destroying the baby's red blood cells. This, too, is uncommon in premature infants.