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Neonatal hyperbilirubinemia: what it is, causes and how to treat it


Neonatal hyperbilirubinemia is a disease that appears in the first days of a baby's life, caused by the accumulation of bilirubin in the blood, leaving the skin yellowish.

Any child can develop hyperbilirubinemia, the main causes of which are physiological changes in liver function, blood diseases such as hemolytic anemia, liver diseases caused by infections or genetic diseases, or even reactions during breastfeeding. Also check the causes of high bilirubin and jaundice in adults.

Care to reduce the amount of bilirubin in the blood must be started quickly, and treatment with phototherapy is the most used. In some cases, the use of medication or blood transfusions may be necessary, and are advised by the pediatrician.

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Main features

The main feature of neonatal hyperbilirubinemia is yellowing of the skin and eyes.

Jaundice occurs when the baby is unable to correctly eliminate bilirubin, which is produced by blood metabolism, as, before birth, the placenta performed this function.

How to confirm

Neonatal hyperbilirubinemia can be confirmed by measuring direct, indirect and total bilirubin in the blood:

  • Hyperbilirubinemianoconjugatewhen indirect bilirubin is equal to or greater than 2 mg/dL;
  • Hyperbilirubinemiaconjugatewhen direct bilirubin is equal to or greater than 1 mg/dL.

In addition, the pediatrician must evaluate the symptoms and characteristics presented by the baby, which normally appear when bilirubin levels are above 5 mg/dL. See more about the bilirubin test.

Make an appointment with the nearest pediatrician to have your baby’s signs and symptoms evaluated:

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Causes of neonatal hyperbilirubinemia

The main causes of hyperbilirubinemia in newborns are:

1. Physiological jaundice

It generally occurs 24 to 36 hours after birth, being the most common type of jaundice, as the baby's liver is poorly developed and may have some difficulties in transforming and eliminating bilirubin from the blood through bile. This change normally resolves within a few days, with treatment with phototherapy and exposure to the sun.

How to deal with: Fluorescent light phototherapy is useful for reducing the amount of bilirubin in the blood. In mild cases, exposure to the sun may be sufficient, but in very severe cases, a blood transfusion or medication, such as phenobarbital, may be necessary to obtain better results. Understand better how physiological jaundice in newborns is treated.

2. Breast milk jaundice

This type of increase in bilirubin can happen around 10 days after birth, in some babies who are exclusively breastfed, due to the increase in hormones or substances in the blood that increase the reabsorption of bilirubin in the intestine and make it difficult to eliminate, despite although the exact form is not yet known.

How to deal with: in cases of more severe jaundice, phototherapy can be used to control blood levels, but breastfeeding should not be interrupted, unless advised by your pediatrician. This jaundice disappears naturally around the baby's second or third month.

3. Blood diseases

Some diseases can cause an accumulation of bilirubin in the baby, such as autoimmune or genetic changes, which can be serious and appear in the first hours after birth. Some diseases are spherocytosis, thalassemia or incompatibility with the mother's blood, for example, but the main one is hemolytic disease of the newborn, also known as erythroblastosis fetalis.

How to deal with: in addition to phototherapy to control the amount of bilirubin in the blood, treatment is generally carried out with a blood transfusion and, in some cases, medications can be administered to control immunity.

4. Liver diseases

The baby may be born with changes in liver function, due to various causes, such as bile duct deformities, cystic fibrosis, congenital rubella, congenital hypothyroidism, viral or bacterial infections, or genetic syndromes, such as Crigler-Najjar syndrome, Gilber and Gaucher disease, for example.

How to deal with: to control blood hyperbilirubinemia, in conjunction with phototherapy, treatments are carried out to improve the disease that caused the increase in bilirubin, such as treating the infection with antibiotics, surgery to correct liver malformations or hormone replacement in hypothyroidism, for example example.

Treatment to reduce very high bilirubin in the body, especially phototherapy, must be carried out quickly after detecting the change, as excess bilirubin in the baby's body can cause serious complications, such as brain poisoning known as kernicterus, which causes deafness. , convulsions, coma and death.