Elevated Bilirubin Levels in Newborns: When to Seek Further Care

Liver and gallbladder diseases

The baby is currently over one month old, but has a high bilirubin level.
The first test showed T-BILIRUBIN 7.2, DIRECT-BILIRUBIN 3.8; the second test showed T-BILIRUBIN 7.1, BILIRUBIN 3.6; and the third test showed T-BILIRUBIN 5.6, BILIRUBIN 3.1.
Is this decrease in bilirubin levels significant? Should we follow up at a larger hospital for liver and biliary diseases? The third test results showed GOT 73, GPT 40, and r-GT 263.
Should we continue oral medication to monitor the bilirubin levels? The child was born with signs of cardiac hypertrophy, but has currently recovered to 90%.

Mi Lao Shu, 30~39 year old female. Ask Date: 2006/05/12

Dr. Xie Kaisheng reply Rare Disease

Based on your description, your baby is experiencing pathological jaundice, indicating that there is an issue with the production and processing of bilirubin in their body, which requires further evaluation and treatment.
Generally, neonatal jaundice should be closely monitored under the following five circumstances:
1.
Jaundice appearing within the first 24 hours after birth.

2.
A rapid increase in serum bilirubin levels exceeding 5 mg/dL per day.

3.
Serum bilirubin levels exceeding 15 mg/dL.

4.
Conjugated bilirubin concentration exceeding 1.5 mg/dL.

5.
Jaundice persisting beyond two weeks after birth.

Your baby falls under the fourth condition.
There are many common causes of pathological jaundice, including hepatogenic, extrahepatic toxic, genetic, congenital metabolic disorders, and infections.
If conjugated bilirubin exceeds 1.5 mg/dL, biliary atresia is one of the most serious conditions that requires urgent surgical intervention.
Additionally, consideration should be given to whether it is neonatal hepatitis syndrome.
Infectious diseases such as bacteremia and intrauterine infections, or rare endocrine genetic disorders such as galactosemia, alpha-1 antitrypsin deficiency, Alagille syndrome, and cholestatic jaundice syndrome, are also possible causes.
The reason for cardiomegaly may be related to jaundice; typically, blood oxygen levels in term infants should be greater than 99%.
If it is only 90%, that is insufficient, and a cardiac ultrasound should be performed to check for congenital heart disease.
In summary, pathological or prolonged jaundice, cardiomegaly, and low blood oxygen levels should be further investigated at a major hospital, including blood tests, ultrasound scans, and possibly hospitalization, to prevent any unfortunate outcomes.

Reply Date: 2006/05/12

More Info

Elevated bilirubin levels in newborns, commonly referred to as jaundice, are a frequent concern for parents and healthcare providers alike. Understanding the implications of these levels and when to seek further care is crucial for the health and development of the infant.

In your case, the bilirubin levels you provided indicate a gradual decrease over time, which is a positive sign. The total bilirubin (T-BILIRUBIN) levels you reported were 7.2, 7.1, and 5.6 mg/dL, while the direct bilirubin (DIRECT-BILIRUBIN) levels were 3.8, 3.6, and 3.1 mg/dL, respectively. The fact that these values are decreasing suggests that the jaundice may be resolving on its own, which is often the case in newborns as their liver matures and becomes more efficient at processing bilirubin.

However, the presence of elevated liver enzymes (GOT, GPT, and r-GT) raises some concerns. In your case, the GOT (AST) level of 73, GPT (ALT) level of 40, and r-GT level of 263 are indicative of potential liver dysfunction or biliary issues. Elevated liver enzymes can suggest that the liver is under stress or that there may be an underlying condition affecting its function.
Given the complexity of liver function and the potential for underlying conditions, it is advisable to follow up with a pediatrician or a pediatric gastroenterologist. They may recommend further testing, including imaging studies or additional blood tests, to evaluate liver function and rule out conditions such as biliary atresia or metabolic disorders.
In terms of your question about whether to continue oral medication or seek care at a larger hospital, it is essential to consult with your healthcare provider. If the bilirubin levels continue to decrease and the liver enzymes normalize, it may be appropriate to continue monitoring at home. However, if there are any signs of worsening jaundice, such as increased yellowing of the skin or eyes, poor feeding, lethargy, or any other concerning symptoms, immediate medical attention should be sought.

Additionally, the fact that your baby was born with a heart condition that has since improved to 90% functionality is encouraging. However, it is crucial to ensure that any potential complications related to the heart or liver are monitored closely, as both systems can be interrelated in terms of overall health.

In summary, while the decreasing bilirubin levels are a positive sign, the elevated liver enzymes warrant further investigation. It is essential to maintain open communication with your healthcare provider and follow their recommendations for monitoring and potential referrals to specialists. Early intervention can be key in managing any underlying conditions effectively, ensuring the best possible outcomes for your child's health.

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