Lauren Cavender

NUR 176

Hyperbilirubinemia

Hyperbilirubinemia by definition means elevated total serum bilirubin levels. Bilirubin is

a product of hemoglobin degradation which occurs once red blood cells reach the end of their

lifespan. Bilirubin can be found in the body in two different forms, conjugated or direct bilirubin

and unconjugated or indirect bilirubin (1). Unconjugated bilirubin is highly insoluble and

requires conjugation to a soluble form by the liver in order to be eliminated from the body. If

there is a malfunction in the process of conjugation, unconjugated bilirubin will accumulate in

the body and result in a state of hyperbilirubinemia. This is a very common occurrence in

newborns as they have an increased concentration of red blood cells and their livers are too

immature to keep up with the conjugation process (3). Normal adult serum bilirubin levels are

0.1-1.2mg/dL, for children the range is 0.2-0.8 mg/dL, and 1-12 mg/dL for newborns.

Hyperbilirubinemia for neonates is classified as a total serum bilirubin level greater than 3

mg/dL (1). It is estimated that 60% of all newborns in the United States will develop some

degree of jaundice in the first week of their life and babies born preterm are more harshly

affected (4).

Signs and symptoms associated with hyperbilirubinemia are usually mild and benign. The

most common indicator of jaundice is yellowing of the eyes and skin. Jaundice develops in a

head to toe manner so the color change is usually first noticed in the face but the trunk and

extremities can also become discolored. In severe cases, elevated serum bilirubin may cause

lethargy, poor appetite, and fever in newborns (2).

 Diagnostic tests for hyperbilirubinemia include a blood test for total serum bilirubin and a

non-invasive method known as transcutaneous bilirubin measurement that uses a flash of light

through the newborn’s skin (5). The transcutaneous method has its limitations when used with

darker skin complexions but evidence shows that when the total serum bilirubin level is less than

15 mg/dL this method provides accurate estimates and is a painless option for babies (5).

As mentioned above, most newborns will experience some degree of hyperbilirubinemia

but as they age through their first few weeks of life their livers will mature and learn to be more

effective at removing the excess bilirubin from the blood (6). Treatment for hyperbilirubinemia

is usually unnecessary unless it does not resolve on its own as expected. For severe cases,

phototherapy may be used which alters the structure of bilirubin to allow it to be eliminated from

the body (3). Phototherapy is largely dependent on the amount of the newborn’s skin that is

exposed to the light.

Potential complications for hyperbilirubinemia are rare but they do sometimes occur. If

jaundice is prolonged, serum bilirubin is greater than 17 mg/dL, or if serum bilirubin rises more

than 5 mg/dL in one day, there may be another pathological factor at play that needs to be treated

such as infection, enzyme deficiencies, hemolytic disorders, or blood-group incompatibilities (3).

Furthermore, unconjugated bilirubin is able to cross the blood-brain barrier and prolonged

elevated levels of serum bilirubin have been shown to cause damage to the basal ganglia and

other brainstem nuclei in a condition known as kernicterus (5).

Hyperbilirubinemia is extremely common and most often benign and will resolve on its

own with time. Family history and certain conditions surrounding a newborn’s birth may

increase the risk of developing hyperbilirubinemia but the complications associated with
neonatal jaundice are usually preventable with diligent assessments and diagnostic testing by

clinicians.
 References

1. LeFever Kee, Joyce. Laboratory and Diagnostic Tests With Nursing Implications. 8th

Edition. 2017, Pearson Education Inc.

2. Cohen, S.M.: Jaundice in the full-term newborn. Pediatric Nursing, 2006; 32(3): 202-208.

http://www.ncbi.nlm.nih.gov/pubmed

3. Dennery, P.A., Seidman, D.S., & Stevenson D.K.: Neonatal hyperbilirubinemia. New

England Journal of Medicine 2001; 344(8): 581-590.

http://www.ncbi.nlm.nih.gov/pubmed

4. Truman, P.: Jaundice in the preterm infant. Pediatric Nursing 2006; 18(5): 20-22.

http://www.ncbi.nlm.nih.gov/pubmed

5. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia: Management of

hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;

114(1): 297-316. http://www.ncbi.nlm.nih.gov/pubmed

6. Porter, M.L. & Dennis, B.L.: Hyperbilirubinemia in the term newborn. American Family

Physician 2002; 65(4): 599-606. http://www.ncbi.nlm.nih.gov/pubmed