Interpreting Conjugated Bilirubin Levels in Newborns Low levels of bilirubin are generally not concerning and are not monitored. Newborns. An elevated bilirubin level in a newborn is mostly temporary and may recover by itself no longer than two weeks. However, if the bilirubin level is above the normal level or increases rapidly, an examination of the cause is needed to confirm the according CB levels between 0.5 and 1.9 mg/dL can be associated with infection, but most often remain unexplained. Liver and biliary disease become increasingly likely as CB levels increase; for CB ≥5 mg/dL, 47% of newborns have biliary disease and 43% have liver disease. In newborns with CB levels ≥0.5 mg/ dL and <2 mg/dL, infection must be ruled out and the newborn should be followed. In newborns with levels ≥2 mg/dL, a more in-depth assessment of the hepatobiliary system is indicated. Conjugated hyperbilirubinemia in a neonate is defined as a serum direct/conjugated bilirubin concentration greater than 1.0 mg/dL if the total serum bilirubin (TSB) is <5.0 mg/dL or greater than Most of the bilirubin gets processed in the liver and passed out through the bile ducts. Processed bilirubin is known as conjugated or direct bilirubin. Unprocessed bilirubin is known as unconjugated or indirect bilirubin. When it comes to unconjugated bilirubin in newborns, this value tends to be higher than the normal value for adults. A small minority of newborns with jaundice have cholestasis with causes including congenital abnormalities and infectious, metabolic, iatrogenic, and idiopathic disorders. 2 Identifying these newborns with cholestasis from the masses of jaundiced newborns can be difficult, but is important for early diagnosis and treatment. For this reason, conjugated bilirubin (CB) and direct-reacting bilirubin levels are often measured. CB levels between 0.5 and 1.9 mg/dL can be associated with infection, but most often remain unexplained. Liver and biliary disease become increasingly likely as CB levels increase; for CB ≥5 mg/dL,... In newborns with levels ≥2 mg/dL, a more in-depth assessment of the hepatobiliary system is indicated. Interpreting conjugated bilirubin levels in newborns J Pediatr. 2011 Apr;158(4):562-565.e1. doi: 10.1016/j.jpeds.2010.09.061. Epub 2010 Nov 12. Authors Adam Rahn Davis 1 © 2021 The Regents of the University of California. The University of California San Francisco | UCSF Department of Medicine | UCSF Department of Medicine
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