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What are the harmful effects of high bilirubin levels in a newborn?

Saturday, 08 January 2005
Answered by: Dr. P.S.N. Menon
Consultant & Chairman, Department of Pediatrics,
Armed Forces Hospital,
Kuwait
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Q. My daughter was born 2 weeks before the expected delivery date. She weighed 3 kg. After a few days, I noticed a slight yellow colour in her skin. Phototherapy was done for half an hour but was discontinued as the doctor asked us to wait for the blood test result. Blood test revealed a bilirubin level of 15. After 2 days, phototherapy was done 4-5 times for 30 minutes each. Blood test on the next day showed a bilirubin level of 23.5 and baby was shifted to NICU for continuous phototherapy. Her haemoglobin was 21 and her weight had come down to 2.6 kg from 3 kg. That night the yellow colour increased further. From one NICU staff I came to know that her bilirubin had reached 27 but I am not too sure. Hospital authorities say that they did not do blood transfusion as the baby was active and Hb was 21. Baby was sucking milk. But she slept off while sucking. Her bilirubin came down to 17.4. Now her bilirubin is 14.5. She is active now, sucking milk. There is a little bit of yellow colour in the body and eyes. Is there any chance of brain already being affected when the bilirubin reached 23.5 / 27? How can we ensure that nothing went wrong? What are the tests to be performed?

A.  There is no specific method by which a pediatrician can state clearly that the brain of the baby will be affected by the jaundice in the newborn. Tests like BERA, EEG and imaging have a limited role in detecting the potential brain abnormalities. The chances are the baby is less likely to be affected as she is active and sucking well. It is also important to know whether the conjugated or unconjugated bilirubin was high and also what is the cause for the high bilirubin. With the Hb being 21, it is unlikely to be due to a blood group incompatibility, which is known to cause rapid rise in bilirubin and consequent involvement of brain. The colour of the skin is not a good guide for jaundice, especially after phototherapy. Follow up evaluation of the baby by a competent pediatrician is essential to detect neurodevelopmental problems, if any.

A.  There is no specific method by which a pediatrician can state clearly that the brain of the baby will be affected by the jaundice in the newborn. Tests like BERA, EEG and imaging have a limited role in detecting the potential brain abnormalities. The chances are the baby is less likely to be affected as she is active and sucking well. It is also important to know whether the conjugated or unconjugated bilirubin was high and also what is the cause for the high bilirubin. With the Hb being 21, it is unlikely to be due to a blood group incompatibility, which is known to cause rapid rise in bilirubin and consequent involvement of brain. The colour of the skin is not a good guide for jaundice, especially after phototherapy. Follow up evaluation of the baby by a competent pediatrician is essential to detect neurodevelopmental problems, if any.

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