Bilirubin is a yellowish substance made when red blood cells are broken down. It passes through the liver, gallbladder and digestive tract before being excreted. High bilirubin levels are more common in babies. Babies have a high number of red blood cells in their blood and break them down more quickly. Their livers may not be developed sufficiently to keep up. When there is too much bilirubin in the blood, or the liver cannot excrete all of it, this leads to jaundice, a yellow colouring of the skin.
Jaundice usually starts to appear on a baby’s face first before spreading to the chest, stomach, arms and legs. Babies are checked for jaundice following birth and at the 5 day post-birth check. Babies born to East Asian or Mediterranean families are more likely to develop jaundice, as are babies whose siblings had jaundice. It can be harder to detect jaundice in a baby with darker skin colour. Checking the gums and inner lips may help with detection. If there are any concerns, then blood tests can be done to confirm a diagnosis.
It is estimated according to the NHS, that 6 out of every 10 babies develop jaundice, including 8 out of 10 babies born prematurely before the 37th week of pregnancy. However, only around 1 in 20 babies has a blood bilirubin level sufficiently high enough to need treatment (treatment is not often required and symptoms usually pass within 10 to 14 days).
Treatment, when it is required, is carried out at hospital. It usually involves either phototherapy, shining special lights onto the baby’s skin to help the liver break down the bilirubin more easily, or an ‘exchange transfusion’ (a blood transfusion).
When a baby has very high levels of bilirubin and this is left untreated for too long, it can cause a condition called kernicterus. Kernicterus is a form of brain damage. It can cause cerebral palsy and hearing loss. It can also give rise to problems with the baby’s vision (with difficulty maintaining normal eye movements), to problems with the development of their teeth and can also cause learning disabilities.
Early symptoms of kernicterus in babies include irritability, poor feeding, lethargy, high-pitched crying, lack of the startle reflex, floppy muscles and brief pauses in breathing. Treatment involves a blood exchange transfusion. Early detection and treatment is crucial when kernicterus develops to prevent extensive permanent brain damage.
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