What is the Highest Bilirubin you've ever seen?

Specialties NICU

Published

Just curious. :wink2:

Specializes in NICU.

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

I don't want to even imagine!

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.

Specializes in Maternal - Child Health.
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.

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.

Specializes in Community, OB, Nursery.

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.

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.

Specializes in medical.

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

Specializes in Neonatal ICU (Cardiothoracic).
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.

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.

We see things like prematurity (between 34 and 37 weeks), ABO incompatibility, large cephalohematoma or excessive bruising, poor breastfeeding with no supps allowed, fever. Or any combination of the above.

All of our kids who aren't already scheduled for a serum bili level get a BiliChek on their second day as a screening tool. For those not familiar with the term, that's a non-invasive light meter test done on the forehead. It can be done whenever we think a baby looks too yellow or ruddy. We check the results against the Bhutani graph that factors in the level we get against the age of the baby (in hours).

If a nurse thinks a baby needs a level apart from that second day reading, she can do a BiliChek at any time. Nurses can order serum bili levels, too. We've made a number of good catches that allowed a child to start treatment quickly.

The hospital where two of my daughters just had their babies does not do routine screening. And nurses can't order serum bili levels, only the docs. We specifically had to ask for a level for the wee one born in August, even though he had three risk factors--ABO incompatibility, cephalohematoma, and exclusive breastfeeding, and he looked jaundiced. His level was in the moderate risk range, but he was monitored closely after leaving the hospital and he was all right. It did bother me (and his nurse), though, that the doc (covering for their regular ped) had to be asked for a serum bili.

With all the monitoring tools we have and our ability to treat high bilirubin levels aggressively, kernicterus is a condition that just shouldn't happen.

Specializes in Maternal - Child Health.

With all the monitoring tools we have and our ability to treat high bilirubin levels aggressively, kernicterus is a condition that just shouldn't happen.

Miranda, you're right. And thankfully, it is very rare. I've only seen one (presumed) case in 11 years, but what made it so terribly tragic was that it should have been prevented.

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.

:eek: I would have called CPS!

Apparently the peds didn't care enough to argue. He discharged the baby... I would love to know if she is still even alive or if she died of dehydration.

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