Hyperbilirubinemia in the newborn

Total Bilirubin (TB) can vary based on infant diet, gestational age, ethnicity. This is likely due to variations in hepatic uptake and clearance

Peak levels:

• White and Blacks: TB level peaks at 48-96hrs (2-4 DOL) at 7-9mg/dL with 95th percentile ranging from 13-18mg/dL
• Eastern Asian: TB level peaks at 72-120hrs (3-5 DOL) at 10-14mg/dL

Time to resolution:

• Visible jaundice resolves within 1-2wks of life
• Clinical Jaundice typically resolves by 1 wk in formula-fed white and black infants and by the 10th day in eastern asian infants
• Jaundice typically resolves within 3wks in 65% of breastfed infants (20% still jaundiced at 4wks)

 NOTE: If Hyperbilirubinemia continues > 2wks, obtain Total and Direct Bilirubin (r/o conjugated hyperbilirubinemia)

Risk factors for significant unconjugated hyperbilirubinemia:

• Increased Production
• Isoimmune-mediated hemolysis (ABO or Rh incompatibility)
• Inherited RBC membrane defects (spherocytosis, elliptocytosis)
• Erythrocyte enzymatic defects (G6PD, pyruvate kinase deficiency, congenital erythropoietic porphyria)
• Sepsis
• Polycythemia, sequestration (cephalohematoma)
• Macrosomic Infants of diabetic mothers
• Decreased Clearance
• Crigler Najjar
• Gilbert
• OATP-2 polymorphism
• Maternal DM, congenital hypothyroid, galactosemia, panhypopit
• Increased enterohepatic circulation
• Breast Milk Jaundice: presents after 3-5 DOL, peaks within 2wks after birth, progressively normalizes over 3-12wks (after 2 wks check direct bili to ensure not alternate etiology present)
• Ileus or intestinal obstruction. Increases enterohepatic circulation of bilirubin
• Lactation failure jaundice (Breastfeeding Jaundice) - inadequate intake of fluid and calories leading to weight loss, hypovolemia

 Treatment: See nomogram