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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

House Call: Condition common in babies can have underlying cause

Dr. Alisa Hideg

You may recall from my column on sickle cell disease that it is normal for your red blood cells to live 90 to 120 days and then die. As your body breaks down dead red blood cells, one of the byproducts of this degradation is bilirubin. Red blood cells are always dying and being replaced, so it is normal to have some bilirubin in your body at all times. But if you’re making bilirubin faster than usual or clearing it from your body slower than usual, it can build up in your blood. This buildup is called hyperbilirubinemia.

If you have had a baby, it is possible that your newborn developed hyperbilirubinemia. The most noticeable symptom is jaundice, yellowish skin, caused when there is enough bilirubin in the blood that it starts to accumulate in other parts of the body like the skin.

Mild hyperbilirubinemia is relatively common in full-term newborns – around 60 percent of babies born at full term develop hyperbilirubinemia. It is even more common in premature babies, with about 80 percent developing it. It usually appears on the second or third day of life. In most infants, it resolves itself in two to three weeks as their livers finish developing and can effectively clear the bilirubin. However, hyperbilirubinemia should be taken seriously and monitored. In more severe cases treatment may be needed to prevent brain damage caused by a buildup of bilirubin in the brain.

Along with yellowish skin, the whites of a baby’s eyes with hyperbilirubinemia will also become yellowish. Other symptoms to watch for include sluggishness, poor feeding, crankiness, jitteriness, arching the back and a high-pitched cry. If your baby is becoming more yellow after day three of life, have it checked out by a health care professional.

When hyperbilirubinemia in a baby is severe enough to require treatment, phototherapy is usually used. The baby is put under a special light for a few hours daily. The light causes a photochemical reaction and the bilirubin is changed into a different substance that the body can get rid of more easily. In some cases a baby may need a blood transfusion. It’s also essential that the baby get enough to eat so that the baby’s liver continues to mature and develop and clear more bilirubin from the body.

If your baby has hyperbilirubinemia, it is important to be sure of the cause. Aside from lag time in a baby’s liver development, other conditions that can cause hyperbilirubinemia are Rh incompatibility, Gilbert’s disease, Crigler-Najjar syndrome, Dubin-Johnson syndrome, obstruction of the bile duct, viral or bacterial infection, sickle cell disease and internal bleeding. Your doctor may want to run other tests if an underlying condition is suspected.

Hyperbilirubinemia can also occur in adults, and the most noticeable symptom is also jaundice. It should be taken seriously because causes range from benign to life-threatening and include infectious hepatitis, drug reactions, autoimmune disorders, gallstones that block the bile duct, biliary tract infection, pancreatitis and cancer.

To determine the cause of hyperbilirubinemia in an adult, your doctor may order a urine test, complete blood count test, liver function tests and tests for infectious hepatitis. In some cases, abdominal ultrasound or CAT scan may be recommended, and in rare cases examination of the bile ducts using contrast dye or a liver biopsy may be needed to come to a diagnosis.

Many of the underlying conditions in adults that cause hyperbilirubinemia can be treated with good outcomes, so it is important to see you doctor if you notice yellowing of the skin or eyes.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.