From the Research
Yes, bilirubin levels typically increase through day 5 in newborns, and a 48-hour-old infant with a level of 185 μmol/L (10.8 mg/dL) will likely see further increases over the next few days. Bilirubin levels generally peak between days 3-5 of life in term infants, as supported by a study published in 2017 1. This is due to the natural breakdown of fetal hemoglobin, increased enterohepatic circulation of bilirubin, and the newborn liver's immature ability to conjugate and excrete bilirubin. Some key points to consider:
- The 2017 study 1 found that universal bilirubin screening programs can accurately predict and prevent severe hyperbilirubinemia.
- A 2002 study 2 recommended phototherapy when the total serum bilirubin level is at or above 15 mg per dL (257 micromol per L) in infants 25 to 48 hours old.
- A 2000 study 3 found that a serum bilirubin level of ≥6 mg/dL on the first day had the highest sensitivity (90%) for predicting significant hyperbilirubinemia. For a 48-hour-old infant with a level of 185 μmol/L, close monitoring is essential, as recommended by a 2017 study 4. While this level isn't necessarily concerning at 48 hours, the expected rise over the next few days could potentially reach levels requiring intervention. Some key considerations for management include:
- Watching for signs of increasing jaundice
- Ensuring adequate feeding to promote bilirubin excretion
- Following up with repeat bilirubin measurements as recommended by the pediatrician
- Considering phototherapy if levels continue to rise significantly, as recommended by a 2002 study 2 It's essential to interpret bilirubin levels in the context of the infant's age in hours, gestational age, and risk factors for severe hyperbilirubinemia, as highlighted in a 1995 study 5. Use of a nomogram or risk assessment tool can help guide management decisions.