What Is Indirect Hyperbilirubinemia?

Newborn babies, simply because they have not been exposed to much outside the womb, often experience multiple medical conditions. Most of these conditions are not serious, such as dry skin, cradle cap and rashes. These conditions usually go away as the baby's immune system gets stronger and don't require any treatment. However, some conditions do need medical attention. One such condition that may warrant a stay in the hospital for a newborn is indirect hyperbilirubinemia.

Definition

• Hyperbilirubinemia is the build up of the chemical bilirubin, a by-product of red blood cells breaking down, in the body. When the bilirubin can be excreted by the liver, this is called direct hyperbilirubinemia. If the bilirubin cannot be excreted and is instead circulating in the blood, this is called indirect hyperbilirubinemia. The pigmentation of the bilirubin is yellow. Jaundice occurs when there is hyperbilirubinemia.

When It Occurs

• Hyperbilirubinemia usually appears in newborns anywhere from 24 hours to 2 weeks after birth, although this is an average. The sooner the jaundice appears, the more serious the hyperbilirubinemia is considered to be.

Reason for Concern

• Bilirubin in small amounts generally causes no problems. However, large amounts can build up in the brain. This can result in brain damage, seizures or both.

Symptoms

• The most common symptom of hyperbilirubinemia is yellowing of the skin due to the pigmentation of the bilirubin. This actually can be difficult to detect in some cases because the coloring of the skin can change so gradually that caregivers do not notice it. Individuals with darker skin tones can mask the poor coloring. An additional symptom includes lethargy.

Treatment

• When bilirubin cannot be excreted, the most common way to remove it from the body is to break it down. Most hospitals do this with special lights and light blankets. The treatment is painless to the baby and usually takes only a few days. However, the condition can be caused by multiple things, including breast feeding. Sometimes treatment includes cessation of breast feeding for a short period, a blood transfusion or treatment for an infection that might have caused the bilirubin levels to rise.

Why It's Common

• Newborns simply are not as physically developed as adults are. Their tiny livers often cannot break down the bilirubin in their bodies fast enough, so it builds up. Additionally, the newborn sometimes reabsorbs the bilirubin from the intestine, and they make more bilirubin than adults because they produce more red blood cells at a faster rate.