Hyperbilirubinemia Procedures

Hyperbilirubinemia occurs when there is too much bilirubin in the blood. This causes jaundice in premature and newborn infants. Babies have an inability to get rid of bilirubin at birth for many reasons. Treatments will depend on the reason for the hyperbilirubinemia and the measured levels of bilirubin.

Causes

Hyperbilirubinemia can occur for many different reasons. According to the March of Dimes, jaundice occurs in 60 percent of all newborn babies. Physiologic jaundice occurs within the first few days of life. This is generally a normal response to the baby's inability to excrete bilirubin. Breastfeeding jaundice can occur in infants who may be ingesting less fluid. Pathologic hyperbilirubinemia occurs for several medical reasons such as a blood type incompatibility with the mother, twin-to-twin transfusion, hematomas, and various other medical disorders.

Treatments

There are several treatment options available for hyperbilirubinemia. For simple physiologic jaundice increasing feeds and fluids will help resolve the jaundice. Phototherapy may also be used. Phototherapy uses blue and white fluorescent bulbs that are placed above the infant's crib or isolette. An acrylic shield is used to screen out ultraviolet radiation. Blindfolds are placed on the baby to protect the eyes. Fiberoptic blankets can also be used. The blanket is wrapped around the baby. This can be used alone or in conjunction with phototherapy lights. Phototherapy can be used for several hours to many days depending on the bilirubin levels in the baby's blood.

If the bilirubin levels are too high and phototherapy alone is not decreasing the levels, an exchange transfusion may be necessary in certain cases. An exchange transfusion counteracts the effects of jaundice. An exchange transfusion is a procedure for removing the baby's blood by one catheter and replacing it via another catheter at the same time. The exchange transfusion is done slowly and in cycles. The same amount of blood withdrawn out of the infant is replaced by an equal amount of pre-warmed blood. The infant will need to be monitored for several days after the exchange transfusion. There will be additional lab tests to determine if the bilirubin levels have lowered enough or if another exchange transfusion will be necessary.

Warning

Kernicterus is a form of brain damage that can be caused by excessively high amounts of bilirubin in the blood. It is a rare condition. Physicians follow hyperbilirubinemia closely to help prevent the occurrence of kernicterus. Treatment options include an exchange transfusion to prevent kernicterus. Kernicterus is preventable by implementing hyperbilirubinemia treatment procedures. According to the March of Dimes, exact incidences of kernicterus are unknown. There were 125 cases of kernicterus reported to the kernicterus registry between 1984-2002.