What is a Dangerous Level of Bilirubin in Newborns?

Dangerous Bilirubin Levels in Newborns: Symptoms, Causes & Treatment

When your body breaks down red blood cells, it produces a yellowish residue known as bilirubin. Your liver is in charge of processing and eliminating them from your body. However, for newborns, the case is different. Since their livers are immature, they cannot process high bilirubin, leading to jaundice. 

Dangerous Bilirubin Levels in Newborns 

According to AAP guidelines, the danger level of bilirubin depends on a baby's age in hours, gestational age, and risk factors. According to AAP guidelines, bilirubin risk and treatment decisions are based on hour‑specific bilirubin nomograms that account for the infant’s age in hours, gestational age, and neurotoxicity risk factors. No single bilirubin value is universally ‘dangerous. Levels near or above 20 mg/dL may require urgent treatment, depending on the baby’s age, gestational age, health status, and risk factors, as per AAP bilirubin nomogram criteria.  

High levels of unconjugated bilirubin can cross an immature or compromised blood–brain barrier and may lead to kernicterus.  

Symptoms of High Bilirubin Levels in Newborns 

Dangerously high bilirubin levels can indicate hyperbilirubinemia. It is a common condition in newborn babies. 

Symptoms show up as: 

• Develops jaundice within the first 24 hours of life. 
• Has jaundice that seems to be spreading quickly down the body or appears very intense. 
• Is extremely sleepy and difficult to wake for feeds. 
• Is not feeding well. 
    

Has fewer than 6 wet diapers in a 24-hour period. 

Causes of High Bilirubin Levels in Newborns 

There are several causes of dangerously high levels of bilirubin in newborn babies. They are as follows: 

• Mismatched blood type of mother and baby 
• Lack of enzymes 
• Higher than normal levels of red blood cells (common in twins) 
• Infection 
• Bleeding under the scalp 
    

Before birth, the placenta feeds and clears bilirubin from the baby. However, after birth, this responsibility falls to the liver. Many times, it cannot process the excessive bilirubin produced by red blood cell breakdown. The process of red blood cell breakdown is also known as haemolysis. 

Complications of High Bilirubin Levels in Babies 

If bilirubin levels are too high, it can cause a myriad of problems and complications. They are: 

• Kernicterus (Brain Damage): Severe unconjugated hyperbilirubinemia may allow bilirubin to cross an immature or compromised blood–brain barrier, increasing the risk of bilirubin‑induced neurologic dysfunction. Risk depends on multiple clinical factors, not a single bilirubin value.  This can lead to permanent brain damage (kernicterus). Symptoms include constant upward gaze, uncontrolled movements, and hearing loss. Moreover, it may also cause defects in the baby's tooth enamel. 
• Acute Bilirubin Encephalopathy: Acute bilirubin encephalopathy presents with lethargy, hypotonia, poor feeding, and high‑pitched cry. Chronic bilirubin encephalopathy (kernicterus) results in permanent neurologic sequelae such as athetoid cerebral palsy, sensorineural hearing loss, and enamel dysplasia. . This includes fever, listlessness. Moreover, it can cause the neck and body to arch backwards, along with high-pitched crying. Poor feeding and sucking and fever are also symptoms of acute bilirubin encephalopathy. 

Preventing High Bilirubin Levels in Newborns 

Although some level of jaundice is common for babies, parents can prevent severe levels of bilirubin in the body. 

• Before birth, expectant mothers must test for unusual antibodies and blood type. Rh-negative mothers should test the baby’s umbilical cord as well. 
• Parents should feed the baby 8-12 times a day after birth for several days. 

Doctors and healthcare professionals must: 

• Identify high-risk babies. 
• Check bilirubin levels at 24 hours. 
• Follow up on bilirubin levels within 2 days. 
    

Treatment for Dangerously High Bilirubin Levels 

In case of extremely high bilirubin levels, doctors may use phototherapy to treat the baby. In this, they place the newborn in an enclosed bed with a blue light on top. This blue light helps break down bilirubin in the skin. 

The baby only wears special sunglasses and a diaper during this time. However, mothers can continue to breastfeed. Phototherapy is the primary treatment. Exchange transfusion is used in severe cases. IV fluids are only indicated when dehydration or systemic illness is present. 

Newborn babies are susceptible to jaundice, which is a common occurrence. Most jaundice resolves on its own within 2 weeks. However, when bilirubin levels are too high, immediate treatment is necessary. 

Disclaimer: This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Bilirubin levels and treatment decisions vary based on a newborn’s age, gestational age, and clinical condition and must be evaluated by a qualified healthcare professional. Always consult a pediatrician or neonatologist if your newborn shows signs of jaundice or illness. 

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