|Photo by Cheryl via Flickr|
We certainly see babies coming into offices at 3 and even 4 weeks of age still looking somewhat
yellow, prompting us to check a bilirubin level and finding an unconjugated level still over 5 mg/dL. Is this prolonged level normal? Should we worry and keep checking levels or reassure parents that all is well?
Maisels et al. (doi: 10.1542/peds.2013-4299) looked into this issue of the natural history of hyperbilirubinemia and jaundice in newborns by measuring transcutaneous bilirubin levels in predominantly breastfed infants over 35 weeks gestation.
The results suggest that almost a third of breastfed infants will stay jaundiced for their first month of life. As to whether a particular level of bilirubin correlates with the color or location of the jaundice, the authors looked into this as well. Their findings were interesting confirming the lack of accuracy of predicting bilirubin by distribution of visible jaundice, but reassuring in that the wide range of levels obtained by severity of color do not appear to be high enough to be worrisome.
The brief summary in this post just begins to skin the surface on a nice study well worth reading in its entirety to have a better understanding of when to worry and not to worry about persistent unconjugated jaundice in breastfed infants.