Re: What is the Highest Bilirubin you've ever seen?

Just curious...

What is a normal bilirubin level?

I'm not a NICU nurse, I'm just a pre-nursing student who hopes to be one after I graduate and I love learning so many interesting things from this forum!

Re: What is the Highest Bilirubin you've ever seen?

Mid 30's on a "well baby" who had been DC'd home then readmitted.

Based on physical exam and neuromuscular abnormalities, we believe the child had kernicterus.

Very sad.

Re: What is the Highest Bilirubin you've ever seen?

So far - 26. My favorite resource RN had a transfer admit who was at 34.

I don't want to even imagine!

Re: What is the Highest Bilirubin you've ever seen?

I do postpartum, and, as our kiddos are generally healthy, we don't usually see numbers above the mid-teens. Then we aggressively treat them with triple phototherapy. I don't recall any of our kids needing exchange transfusions.

What I would like to know is how long can a baby live with the higher numbers and still come out relatively normal? Does there have to be liver damage or extreme hemolysis or some other factor to get the numbers into the upper twenties and beyond?

If left untreated or treated only with phototherapy, how long does it take for the level to come down to a safe level?

Finally, how long does it take to find out if permanent damage has been done and how severe it is?

Thanks for the info.

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by rn/writer

I do postpartum, and, as our kiddos are generally healthy, we don't usually see numbers above the mid-teens. Then we aggressively treat them with triple phototherapy. I don't recall any of our kids needing exchange transfusions.

What I would like to know is how long can a baby live with the higher numbers and still come out relatively normal?

Not very long. By the time a baby displays the s/s of kernicterus, (jaundice, lethargy, difficult to arouse, poor feeding, altered muscle tone, altered cry) brain damage has likely already occurred. The goal of treatment at this point is to minimize damage.

Does there have to be liver damage or extreme hemolysis or some other factor to get the numbers into the upper twenties and beyond?

No. Simple dehydration due to poor breastfeeding will suffice.

If left untreated or treated only with phototherapy, how long does it take for the level to come down to a safe level?

Completely untreated, jaundice will last for weeks to months. Even with phototherapy, jaundice will persist for weeks in a breastfeeding baby. Phototherapy is DC'd when the bilirubin is no longer at a critical level, but it will take weeks for the baby to completely clear the excess bilirubin from his/her system. If a baby has a critically high bili level, an exchange transfusion will be done. In this circumstance, relying on phototherapy alone would risk brain damage, which is unacceptable when an exchange will rapidly lower the bili level. An exchange transfusion is always followed by phototherapy because the underlying cause of jaundice is stll present and the bili will rise again.

Finally, how long does it take to find out if permanent damage has been done and how severe it is?

Thanks for the info.

Clinical evidence of brain damage will be immediately apparent. I've listed the early s/s above. Indicators of severe damage include altered ability to suck, temperature instability and seizures. Imaging studies may be done to look for deposits in the brain, but are open to interpretation.

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by rn/writer

I do postpartum, and, as our kiddos are generally healthy, we don't usually see numbers above the mid-teens. Then we aggressively treat them with triple phototherapy. I don't recall any of our kids needing exchange transfusions.

It's interesting you say that because all of our high bilirubin babies have come from the newborn nursery. Mostly kids with a 12 hour bili of 15 because of hemolytic anemia.

Re: What is the Highest Bilirubin you've ever seen?

We transfer a kiddo to NICU every now and then r/t high bili, but it's rare. I think the highest serum bili I've seen was 19. That kid did get sent to NICU because he was a 35 weeker already on double lights.

Re: What is the Highest Bilirubin you've ever seen?

We got called to Peds for a 2 day old whos bili was 24 or something. The kid was dehydrated like no other and was a home birth. After a million lab draws and one IV gone bad, the parents said they would rather their baby die then to get poked again so the Peds let them take her home. I nearly threw up after being told that.

Re: What is the Highest Bilirubin you've ever seen?

what's an IGG if you don't mind me asking?

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by *minnie**mouse*

what's an IGG if you don't mind me asking?

Immunoglobulin G.

It's an immunoglobulin that can cross the placenta from mom and attack the fetus.