Hyperbilirubinemia is a condition in which there is too much bilirubin in the blood. Most bilirubin comes from the normal breakdown of old red blood cells. Babies are not easily able to get rid of the bilirubin and it can build up in the blood, tissues and fluids of the baby's body, according to the University of Virginia. Because bilirubin has a pigment or coloring, it causes a yellowing of the baby's skin and tissues, called jaundice. Neonatal jaundice is a common occurrence among newborns. In most cases, jaundice resolves itself uncomplicated. However, if your baby's bilirubin exceeds a safe level, complications will develop.
Acute Bilirubin Encephalopathy
Acute bilirubin encephalopathy, or ABE, is the initial toxicity when bilirubin levels are extremely high. Acute encephalopathy usually progresses through three different phases, notes the March 2009 issue of "Critical Care Nursing Clinics of North America." In phase one, a baby would act sleepy, not eat much and have decreased muscle tone. If these symptoms were left untreated, the baby's condition would quickly worsen. If he progressed to the next phase, he would show signs of fever, backward arching of the neck, irritability and marked stupor or difficulty arousing. In the last phase, the baby would cry shrilly, have seizures, gasp for air and be near death.
Kernicterus
Bilirubin toxicity causes chronic and permanent damage, or kernicterus. With kernicterus, there is brain cell death and yellow staining of the brain because bilirubin has crossed the blood-brain barrier into the cell bodies or gray matter, causing irreversible damage. If baby survived after this, he would have permanent brain damage, quite often resulting in cerebral palsy, deafness and mental retardation. According to the May 2004 issue of "Pediatrics", upon discharge from the hospital, the medical provider should have plans to follow up with the baby if there are any concerns about his jaundice.
Response to Phototherapy
Phototherapy treats jaundice in the hospital or at home. While under the lights, the baby would need to take his clothes off and wear protective eye shields. According to the "Handbook of Neonatal Intensive Care", bronze baby syndrome can develop as a result of using phototherapy. The baby would have a dark gray-brown discoloration of the skin. It may be due to the byproducts that phototherapy causes and that remain in the body. Once therapy is finished, he will resume his normal color. Loose watery stools and transient rashes can also occur during treatment. The baby's fluid intake and electrolyte balance must be closely monitored since he will be at risk for imbalances while receiving phototherapy.
References
- University of Virginia Health System: High-Risk Newborn: Hyperbilirubinemia and Jaundice
- "Critical Care Nursing Clinics of North America"; Hyperbilirubinemia; Robin Watson; March 2009
- "Pediatrics": Hospital Stay for Healthy Term Newborns; Carol Miller; May 2004
- "Handbook of Neonatal Intensive Care"; Gerald B. Merenstein, Sandra L. Gardner; 2006
