Interpreting Bilirubin Levels

[Novella]

I've been searching the web for information on newborn jaundice and am a bit confused. My friend was disappointed this morning to find out her new son was not being discharged from hospital as planned, due to high bilirubin levels.

She told me, "The doctor says anyone over 200 can't be released" and that the baby tested around 260-280 (she couldn't quite remember). When I looked up the reference range for newborn bilirubin, these numbers made no sense to me. I found:

cord 24 hrs <1.8 mg/dl
Preterm < or = 6.0 mg/dl
Term < or = 6.0 mg/dl
48 hrs
Preterm < or = 8.0 mg/dl
Term < or = 7.0 mg/dl
3-5 days
Preterm < or =12.0 mg/dl
Term < or =12.0 mg/dl
1m-adult < 1.0mg/dl

What does this "mg/dl" mean, exactly?

Then later, I also found a reference citing numbers similar to what my friend's doctor was discussing:

"Total bilirubin does not usually rise above 200 μmol/L, and in more than 90% has fallen to within the adult reference range by the 7-10th day. Bilirubin concentrations greater than 100 μmol/L in the first 24 hours after birth or greater than 300 μmol/L at any time in normal-term infants are not physiological and warrant investigation."
(at http://www.ukneqas.org.uk/Standards_KJ_FM.pdf)

What does "μmol/L" mean?

Can these two measurements be compared somehow?

I was reading guidelines on Ronnie Falco's website, but they cite the first type of measurement.

[momileigh]

I looked it up in Anne Frye's book and there is a chart that shows values in mg/dl and umol/L. 12=205, 15=257, 17=291, 18=308.

Is the baby home yet?

[Defenestrator]

When looking at jaundice, it is not only the number that you are looking at but how old the baby is. If the numbers are high in the first 24 hours, then the chance that the baby would need treatment to be well is higher. With a number that high on day 1, the doctors are thinking that it is likely to go higher (because jaundice typically peaks on day 3-6) and so they would not want to release the baby because they would be afraid of the bilirubin reaching dangerous levels.

Jaundice like that probably warrants treatment, but around here if my pediatrician advocated for me I could probably get my baby out of the hospital and do a home light blanket treatment coupled with daily blood draws to check bilirubin levels. That is what we did with my first son (he was homebirthed, so there wasn't a hospital to break him out of, but had high bilirubin levels at 24 hours due to ABO incompatibility). So, your friend might be able to get her baby out of the hospital sooner if she gets the baby's pediatrician on her side and presents a care plan to the hospital pediatricians.

Good luck!

[blissful_maia]

How was the baby's bilirubin level tested?

[Novella]

The baby's bilirubin was tested by as a routine blood test prior to planned release. This was done the morning the baby was a full three days old. Unfortunately, no one told the mother the results were beyond their "OK range". She was already discharged, her husband and kids had driven a fair way, and they were preparing for the final details of leaving when someone said, "Hey wait a minute; that baby can't leave" As far as I know, that was the first bilirubin test - there wasn't one done circa 24-hours after birth.

The baby was then started on the bililights and they said baby had to be under them all the time other than whle nursing. 24 hours later, Mom REALLY wanted to go home. She wasn't able to arrange for any home bili-blankets (my guess is our hospitals don't have them). She and I are each in small towns of about 2,000 people, 1-hour's drive from the larger centre she delivered in. My small town hospital has bili-lights. Hers doesn't. Therefore, she couldn't even go home and take baby in to local hospital for sessions.

The pediatrician wasn't exactly able to be brought over to her side as he was the one holding the line on this whole deal. After 24-hours further stay with the bili-lights, they tested again (baby now 4-days-old) and levels were 230. While still not down to their supposed discharge threshold of 200, they said she could take baby home b/c he had responded so well. She agreed to stay until late that afternoon for further light treatment.