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Maternal (Expert Forum)
High Bilirubin levels 3 weeks after birth
Patient medical question and answer from The Maternal and Child Health Forum. Health topic area and articles about newborn care
High Bilirubin levels 3 weeks after birth
by Denis__0, Oct 04, 1998 12:00AM
Our son was born suffering from placental axphia. Most of the ensuing issues cleared up after 2 weeks however his direct bilirubin levels remained high. His ast count reached 299 and is presently dropping. His ggt and ammonia levels were also elevated. An ultrasound was perforemd on the liver and a small stone, 5mm by 7mm was found. A high resolution dye scan was performed which showed the liver functions as normal. We are waiting the results of a liver biopsy. He also has a bladder infection which is being treated with antibiotics. His high bilirubin levels do not translate into a visual yellowing of the skin except in the face and eyes.
Other than the stone what could be causing these levels to be elevated and could this result in a consistent inability to take in formula? We have been tubing the balance of his feeds as he will only take between 20-40 ml's on a consitent basis. He is now 4 weeks old and being treated at the Hospital for Sick Children in Toronto.
Dear Dennis :
Neonatal cholestasis during the first month of life can be due to several etiologies , possible ones include infectious , inflammatory to the liver or obstructive to the biliary canals . Common causes of infection include viral diseases like hepatitis , cytomegalovirus , herpes , epstein barr virus , toxoplasmosis , and the big one , bacterial sepsis . the liver would have to involved and commonly ( not always ) the picture of bilirubin elevation is mixed ( i.e direct and indirect ) . An inflammatory resonse of the liver is another cause ( neonatal hepatitis , a self limiting disease). Now in both these categories , you would be dealing with a hepatitis ( or liver inflammation with signs of cell destruction and decreased function ) which I believe has been excluded by the liver scan . The other category is obstructive , including congenital obstruction of the bile ducts in or out of the liver . This can be detected by ultrasound ( excludes a choledochal cyst ) and or a biliary scan , ending up with a liver biopsy to show bile duct proliferation and can confirm the diagnosis in 95% of the cases .
Occasionally , a sludge may form due to the use of parenteral nutrition and or certain drugs . Those sludges tend to dissolve slowly after discontinuing IV feeding .
I am sure your baby was very sick the first few days and this maybe why he is still having some problems with feeding. Discuss the possibilities with his neonatologist .
L.M
Disclaimer : This information is for educational purposes only . The final management of your child's condition is the responsibility of your health care provider.
Keywords : neonatal cholestasis* ( neonatology , gastroenterology)
