ERNST & YOUNG
High bilirubin can be caused by a variety of factors and is very common in newborns. If you or your child has high bilirubin then the most common symptom is jaundice, which is a yellowing of the skin and the whites of the eyes.
What Is Bilirubin?
Bilirubin is a waste product produced in your blood by red blood cells when they reach the end of their lives. Your liver filters bilirubin out of your system, and it is then excreted. High levels of bilirubin is caused by a wide variety of conditions. While elevated bilirubin itself does not cause symptoms other than jaundice, the underlying condition causing the problem generally does.
What Causes High Bilirubin?
There are a number of causes of high bilirubin and jaundice, some of which are more of a problem than others. In other words, high bilirubin is not so much a disease in its own right, but is more of a symptom.
Here are the most common causes:
- Newborn jaundice. Most newborns show some degree of jaundice because it takes a bit of time for the baby’s liver to take over the job of removing bilirubin from their system. In the vast majority of cases, newborn jaundice goes away in a couple of weeks. Rarely, jaundice can be severe and affect feeding. If not treated it can cause brain damage (bilirubin encephalopathy), but it is easy to treat. Affected infants should feed frequently and may receive phototherapy to help break down the bilirubin. Jaundice is more common in premature infants.
- Gilbert’s Syndrome, which is a genetic condition that affects the liver’s ability to process bilirubin. It can cause jaundice, nausea, and diarrhea.
- Any condition that affects the function of the liver, such as cirrhosis, cancer, or autoimmune disorders.
- Hepatitis, whether caused by a virus, drug use or autoimmune disorders.
- Bile duct inflammation, which causes your liver not to drain bile properly.
- Intrahepatic cholestasis, which is a late-term complication of pregnancy that goes away after the baby is born, but can cause problems for the fetus.
- Hemolytic anemia, which is when blood cells break down too quickly in your bloodstream.
- Pancreatic cancer, which can cause a blockage of the bile duct.
- Certain medications including some antibiotics, birth control pills, and steroids have all been linked to liver problems.
When to See a Doctor
You should see a doctor right away if you have jaundice accompanied by abdominal pain or tenderness, drowsiness or disorientation, black or bloody stools, vomiting blood, high fever, easy bruising or bleeding and a red or purple skin rash. Otherwise, have a doctor check them. Sometimes high bilirubin is not serious. However, sometimes it is. Many of the underlying conditions are treated quickly.
How Do You Treat Jaundice?
In infants, jaundice is treated with phototherapy and fluids. In adults, there is generally not a treatment for jaundice itself. Instead, your doctor will identify and treat the underlying cause. Jaundice will generally go away once the underlying condition has been treated. This might mean medication or surgery (such as to reopen a blocked bile duct), a change of medications (for example, if you get jaundice while on the pill, your doctor may switch you to a different pill or to a different contraceptive method such as a IUD).
Your Baby Has Brain Damage From Jaundice
Untreated jaundice can lead to bilirubin encephalopathy, also called kernicterus. This is most common in babies with Rh hemolytic disease. This is caused by mismatched blood types between the mother and infant. If you and your partner have different blood types, you should have the baby’s blood type checked right away. Symptoms of kernicterus include:
- Extreme jaundice
- Lack of a startle reflex
- Poor feeding
This can progress to an unusually high-pitched cry, irritability, and an arched back with the neck hyperextended backward. Untreated kernicterus can be fatal. Kernicterus is treated in the early stages with light therapy and an exchange transfusion.
Long-term complications can include athetoid cerebral palsy (which causes involuntary movements), a permanent upward gaze, hearing loss or auditory processing disorders and learning disability. The child may also have yellow stains on their primary teeth.
A baby with darker skin often has missed symptoms. Thus, ensure that the hospital checks carefully and ask for bilirubin tests. Bilirubin testing can be done with a transcutaneous device, so there are no needles. There is evidence that African-Americans with a certain deficiency are at higher risk. Combining these factors means that black families need to take extra care to ensure their children are checked for jaundice, and that they should get themselves tested for G-6-PD deficiency (this deficiency is also common in Sephardic Jews, people from the eastern Mediterranean, and those of Chinese descent).
You Had Jaundice During Pregnancy and It Affected Your Baby
Jaundice during late pregnancy can result in fetal distress and preterm delivery. Some doctors actually recommend delivering a couple of weeks early to reduce the effects on the baby.
Studies have shown that babies born to women who had cholestasis during pregnancy are more likely to be overweight or obese, with the health issues that can go along with that.
You may have a case for medical malpractice if your doctor delayed treating moderate to severe jaundice in your baby or was dismissive of jaundice symptoms during pregnancy. As already mentioned, darker-skinned babies are at more risk, as jaundice can be nearly invisible on their skin. Jaundice can also be a sign of serious conditions, and if your doctor did not take it seriously this can also be an issue. The most common problem, though, is untreated or incorrectly treated newborn jaundice that leads to complications.
Because so many infants do have jaundice, it is not taken seriously. Most of the time, it is, and you should not panic if your infant has jaundice. You should, however, make sure to advocate for yourself and your child and get treatment as needed.
If you have a child who has complications from improperly treated jaundice, you should contact Weltchek Mallan & Weltchek for a free initial consultation. We can help you determine whether you have a case against the doctor or hospital to help cover the costs of long term complications and the extra help your child might need.
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Have you or a loved one been injured due to negligence? We want to help. Don’t hesitate to contact us if you believe you have a case; time is an important factor. Interested in learning more? Get in touch with us so we can better evaluate and serve your needs in getting the justice your loved one deserves. You may very well be entitled to compensation.
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