What is the safe level of bilirubin in blood? Here, we deeply analyze the bilirubin levels in newborns, discuss the bilirubin chart, safe level of bilirubin, levels in newborns, levels that require phototherapy, normal range and the jaundice level.
Normal Bilirubin Levels in Newborns Chart
It’s has been estimated that about 60% of full term and about 80% of premature babies develop jaundice (also known as hyperbilirubinemia) in the first week after birth.
The condition happens when red blood cells are broken down, and bilirubin is not excreted from the body thus building up. In most of the cases, the condition is harmless and disappears without any treatment after some weeks.
A few babies might become severely jaundiced, and require investigation and treatment so as to prevent possible complications from developing. To understand the newborn jaundice, firstly, it’s crucial to know there are several forms of jaundice.
It’s normal to have some amount of bilirubin in blood. Older children as well as adults should have bilirubin levels at or below 1mg/dL. Almost all babies have increased amount of bilirubin within 1-2 days of birth. Newborn jaundice is diagnosed when the blood levels of bilirubin are at or over 5mg/dL.
- Physiological jaundice in healthy babies usually sees bilirubin levels of about 5-6mg/dL after 4 days, then dropping over subsequent weeks until reaching the normal levels.
- Breastfed babies are likely to experience than the formula fed babies with levels up to 12 mg/dL. This is known as breast milk jaundice and is said to be an extended form of the physiological jaundice.
- Newborns having multiple risk factors can also develop an exaggerated form of physiological jaundice condition, with the bilirubin levels as high as 24mg/dL.
- Around 20% of healthy breastfed babies develop breast milk jaundice. This begins around 4 days after birth and the levels have been found to be between 12-20mg/dL. Levels begin to fall after about 2 weeks after birth but around 15% of babies having elevated levels at 1 month post birth and it can last until after 12 weeks.
- Pathological jaundice is usually marked by appearance of jaundice within a period of 24 hours after birth, rising bilirubin levels in newborns of more than about 5mg/dL per day, and a bilirubin level higher than 14 mg/dL in a full term newborn. There are several disorders which leads to pathological jaundice like biliary atresia.
Safe Bilirubin Levels in Newborns
While it’s common for the bilirubin levels in newborns to be elevated for the first few days of life, if levels are about 20mg/dL or even more, severe hyperbilirubinemia is then diagnosed. Less than 3% of babies develop this condition. The main factors considered by your baby’s doctor are:
- The age of your baby
- The level of rise of bilirubin.
- Whether your baby was born prematurely. There are two forms of bilirubin that can be measured by the laboratory tests and can assist in determining the cause and treatment for hyperbilirubinemia:
- Indirect or even unconjugated bilirubin – bilirubin is formed and is carried by proteins to liver. Small amounts might also be present in blood.
- Direct bilirubin – is formed in liver when bilirubin combines with the sugars, enters the bile and is then eliminated by stool. Under normal conditions, this type of bilirubin is not present in blood.
In very rare cases high levels of unconjugated bilirubin might be toxic and damage the developing brain cells, causing brain damage known as kernicterus.
Full term babies with risk factors and premature babies might develop brain damage at lower levels of bilirubin than the healthy full term babies. Long-term effects of brain damage are learning and developmental disabilities, movement problems, eye problems, and death.
The exact level which is linked to brain damage in a healthy full term newborn is not indicated and the happening is rare – developing in less than 1% of the newborn babies.
There are several factors which influence toxicity of brain, underlying disease, and how old the baby is.
What Is Considered High Bilirubin Levels in Adults
- Bilirubin is a reddish yellow pigment that is made during the normal breakdown of red blood cells.
- Normal levels vary slightly from one person to another; ranging from about 0.2 – 1.2 mg/dL.
- Signs and symptoms of the high bilirubin levels in adults greatly vary with underlying cause; but, symptoms include jaundice and itching.
- High bilirubin levels in adults implies that there is an underlying problem which involves the red blood cells or gallbladder; but, other problems also might be found.
- Symptoms of high bilirubin levels in newborns are skin and scleral jaundice.
- High bilirubin levels in newborns implies neonate is not processing the red cell breakdown effectively or even an underlying cause is responsible.
- The treatment for elevated bilirubin in adults largely depends on underlying problems. Experts suggest that you avoid alcohol.
- The bilirubin test can determine the total and if required, the conjugated and unconjugated levels of bilirubin in blood.
- The bilirubin test is done on a small sample of blood from patient.
- You prepare for a bilirubin test by refraining from eating for some hours and avoiding some compounds which influence bilirubin levels before the test.
- Risks that are associated with a bilirubin test are very minor.
- The prognosis for adult with the elevated bilirubin levels is largely related to underlying cause, and ranges from good to poor.
- The prognosis for a newborn having elevated bilirubin levels is good in majority of newborns if they rapidly reduce bilirubin levels.
- High bilirubin levels in newborns is prevented in neonates by early treatment, and is presented in adults through treatment of the underlying causes and avoiding consumption of alcohol or other substances which damages the liver.
Bilirubin Levels in Newborns
Bilirubin is a yellow pigment which is in everyone’s blood and stool. Sometimes the liver can’t process the bilirubin in body. This might be because of an excess of bilirubin, or inflammation of liver.
When your body has a lot of bilirubin, your skin and whites of your eyes starts to yellow. This condition is known as jaundice. A bilirubin test assists to determine if you have any of the conditions.
Bilirubin is made in body when hemoglobin protein in the old red blood cells is broken down. The breakdown of old cells is a normal process. After circulating in blood, bilirubin travels to your liver, where it is conjugated, mixed into bile, excreted into bile ducts and stored in your gallbladder. Eventually, the bile is released into small intestine to assist in digesting fats. It’s then excreted within stool.
Bilirubin that is attached by liver to the glucose-derived acid, is known as conjugated, bilirubin. Bilirubin that is not attached to glucuronic acid is known as indirect, or unconjugated, bilirubin. All the bilirubin in your blood together is known as total bilirubin.
A comprehensive bilirubin blood test gets an accurate count of all bilirubin levels in your blood: direct, indirect, and total.
In both adults as well as children, symptoms that are related to high bilirubin involve jaundice, which is yellowing of skin or eyes, fatigue, dark urine and low appetite.
Common reasons to test for bilirubin
If bilirubin is not attached to glucose-derived acid in the liver or is not being adequately gotten rid from the blood, it can then imply that there is damage to liver. Testing for bilirubin in blood is thus a good way of testing for the liver damage.
High bilirubin levels in newborns can either be because of normal changes in metabolism of bilirubin, or it might be the first indication of a medical problem. If the level at birth is high, an infant’s blood can be tested many times in the first few days of life so as to monitor liver function. Jaundice in a newborn can be a serious and life-threatening condition if left untreated.
Another reason for having high bilirubin levels might be that more red blood cells are destroyed than normal. This is known as hemolysis.
Sometimes bilirubin levels in newborns is measured as part of a “panel” of tests. Normally, the liver is evaluated with a group of tests which include:
- alanine transaminase
- alkaline phosphatase
- total protein
How is the bilirubin blood test performed?
Some amount of your blood is required so as to perform this test. The blood sample is obtained through a needle being inserted into a vein through the skin in your arm or even a hand, and a small amount of blood is then collected in a test tube.
How do I prepare for the bilirubin blood test?
For this test, you will require to not eat or even drink anything other than water for a period of about 4 hours before the test is performed. You may drink your usual amount of water before going to laboratory or collection site.
You might have to stop taking some medications before undergoing the test, but only if your doctor tells you to do so. Examples of drugs which affect bilirubin levels are antibiotics such as penicillin G, sedatives, diuretics, and asthma medications.
However, this is not a complete list. There are several other drugs which can influence bilirubin levels. Talk to your doctor before undergoing the test to see if you should temporarily stop or continue taking the medication.
What Bilirubin Level Needs Phototherapy?
Phototherapy is a common treatment that is used for reducing of the high bilirubin levels which are above 20mg/dL which leads to jaundice in a newborn.
In standard form of phototherapy, your baby lies in an enclosed plastic crib and exposed to a type of fluorescent light which is absorbed by baby’s skin. During the process, the bilirubin is changed into another form which can be excreted in the stool and urine.
A baby with jaundice might be required to stay under a phototherapy light for several days. Phototherapy doesn’t damage a baby’s skin, so as a parent, you should not be worried.
During this type of phototherapy:
- The baby is undressed so that as much of skin is exposed to light.
- The baby’s eyes are covered so as to protect the nerve layer that is at the back of the eye from bright light.
- Feeding is supposed to continue on a regular schedule. Do not stop breastfeeding.
- The bilirubin level is then measured at least once a day.
Potential problems which might happen during this standard form of phototherapy include:
- Skin rash.
- Damage to nerve layer that is at the back of eye, if the eyes are not properly protected.
- Dehydration, if the infant does not receive enough fluids while feeding.
- Difficulty in maintenance of proper body temperature.
Another type of phototherapy is through the use of a fiber-optic blanket. These devices wrap around a baby and might also be used at home. Although this method has been indicated to reduce bilirubin levels, it takes longer time than conventional phototherapy that is done in a hospital setting. It might then be a good alternative for babies who are experiencing mild jaundice who are otherwise healthy.
If your baby is treated at home for jaundice, it is important that you as ask the doctor and be explained to on how to use all the equipment. Ask your doctor for help if you have concerns. A home health nurse might also visit so as to make sure that all is going well. The amount of bilirubin which is in your baby’s blood might require to be measured daily.
High levels of a pigment in blood known as bilirubin makes the skin to look yellow.
Everyone’s blood has bilirubin. Bilirubin is one of the byproducts that is created when the old red blood cells break down. Normally, the liver gets rid of the bilirubin from blood and the body removes it in bowel movements.
During pregnancy, the mother’s liver gets rid of bilirubin for her baby. After birth, it then takes a while for a baby’s liver to start getting rid by itself. Pigment builds up in baby’s blood and his skin takes on the yellowish cast of the jaundice.
This type of jaundice, known as physiologic jaundice, appears on a baby’s second or even third day of life and then disappears on its own within a period of two weeks. The yellow color appear first in a baby’s face, then move downward to neck and chest and on down until it reaches his toes.
Bilirubin Normal Range
Some bilirubin in blood is normal. But what is “normal” varies due to the fact that different labs use different measuring techniques or even test different samples. Normal ranges of bilirubin are as follows:
- Direct bilirubin: 0 to 0.3 mg/dL
- Total bilirubin: 0.3 to 1.9 mg/dL
For newborns, bilirubin levels are usually higher during the first 4 or so days of life. Doctors can then evaluate bilirubin levels in newborns based on baby’s risk for severe jaundice and also age in hours.
For a baby having no risk factors, doctors can start worrying about severe jaundice if the level is:
- 24 hours old: 8 mg/dL
- 48 hours old: 13 mg/dL
- 72 hours old: 16 mg/dL
- 96 hours old: 17 mg/dL
If a baby’s bilirubin gets high, doctors can have to monitor the baby closely and then make sure that it begins to decline. Doctors also have to determine how rapidly the level is rising, whether the baby was born preterm and the baby’s age.
- Bilirubin and Bilirubin Blood Test: https://www.medicinenet.com/bilirubin_and_bilirubin_blood_test/article.htm
- Bilirubin Blood Test: https://www.healthline.com/health/bilirubin-blood
- Phototherapy for Jaundice in Newborns – Topic Overview: https://www.webmd.com/parenting/baby/tc/phototherapy-for-jaundice-in-newborns-topic-overview
- Jaundice: https://www.babycenter.com/0_jaundice_89.bc
- Bilirubin Levels and Jaundice: https://www.verywellfamily.com/bilirubin-levels-2748407
- Bilirubin Levels – What’s Normal And What’s Not: https://www.bellybelly.com.au/baby/bilirubin-levels-whats-normal-and-whats-not/