From the Guidelines
Jaundice typically becomes visible when bilirubin levels exceed 2-3 mg/dL (34-51 μmol/L) in adults. Treatment depends on the underlying cause and severity. For physiologic jaundice in newborns, phototherapy is the primary treatment, using blue light to convert bilirubin into water-soluble forms that can be excreted. In severe cases with levels above 20 mg/dL, exchange transfusion may be necessary. For adults, treatment targets the underlying condition: antibiotics for infections, discontinuation of hepatotoxic medications, or surgical intervention for biliary obstruction. Supportive care includes hydration, nutritional support, and sometimes medications like ursodeoxycholic acid for certain conditions.
Key Points to Consider
- Jaundice occurs when bilirubin, a yellow pigment produced during red blood cell breakdown, accumulates in the blood and tissues due to impaired liver function, increased red blood cell destruction, or blocked bile ducts.
- The yellow discoloration typically appears first in the sclera (whites of the eyes), then the skin as levels rise further.
- Phototherapy is commonly used to treat hyperbilirubinemia, with the goal of preventing the total serum bilirubin level from rising above 20 mg/dL (342.08 μmol per L), as reported in a study published in the American Family Physician 1.
- The American Academy of Pediatrics recommends the use of phototherapy to prevent severe neonatal hyperbilirubinemia in newborn infants 35 or more weeks of gestation, with guidelines for the initiation and discontinuation of phototherapy based on the infant's gestational age, neurotoxicity risk factors, and age in hours 2, 3, 4.
- The management of hyperbilirubinemia in newborn infants 35 or more weeks of gestation involves promoting and supporting successful breastfeeding, performing a systematic assessment before discharge for the risk of severe hyperbilirubinemia, providing early and focused follow-up based on the risk assessment, and treating newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus) 5, 6.
From the Research
Bilirubin Level and Jaundice
- Jaundice occurs when the serum bilirubin level exceeds 2.5 to 3 mg/dL 7
- Clinical signs of jaundice are somewhat nonspecific for the underlying etiology of disease, requiring a stepwise approach to evaluation for accurate diagnosis and effective treatment plan 7
Diagnosis and Evaluation of Hyperbilirubinemia
- Evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver 8
- Laboratory tests, including liver chemistry tests (bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and total protein), are necessary for accurate diagnosis 7
Treatment of Hyperbilirubinemia
- Rifampicin therapy may be effective in treating severe hyperbilirubinemia, especially in patients with persistent hyperbilirubinemia 9
- Treatment plans should be formulated based on the underlying mechanism of disease, and liver function tests should be monitored closely 7, 9
Measurement and Clinical Usefulness of Bilirubin
- Elevated plasma bilirubin levels can be secondary to alterations in any stage of its metabolism, including excess bilirubin production, impaired liver uptake, impaired conjugation, and bile clearance defect 10
- Various analytical methods are available for measuring bilirubin and its metabolites in serum, urine, and feces, including diazo transfer reaction, high-performance liquid chromatography (HPLC), and direct spectrophotometry 10