In plain words
Acute bilirubin encephalopathy is brain injury from very in a newborn. is a yellow substance made when old red blood cells break down. Most is harmless. In rare cases, bilirubin rises high enough to cross into the brain. Early signs can include a baby who is very sleepy, hard to wake, feeds poorly, has a high-pitched cry, or stiffens or arches the body. These signs are an emergency. Call 911 or go to the nearest emergency room now. Jaundice care is designed to catch rising levels early, with blood tests and follow-up visits, so that this injury stays rare.
The deeper version
Unconjugated bilirubin crosses the blood-brain barrier when it is not bound to albumin, and deposits in the basal ganglia and brainstem nuclei. Risk is modulated by albumin binding, acidosis, prematurity, hemolysis, and sepsis. The American Academy of Pediatrics guideline (Kemper and colleagues, 2022, Pediatrics) sets and exchange transfusion thresholds by gestational age and by neurotoxicity risk factors, with lower thresholds when risk factors are present. Acute bilirubin encephalopathy progresses through phases and can leave lasting deficits, and denotes the chronic, permanent sequela. The controversy concerns threshold values for late preterm and healthy term infants, since severe injury is now rare and most reported cases involve missed follow-up.
Where it comes up
- Newborn jaundiceBaby Basics
- Feeding a baby with jaundiceFeeding Your Baby
- When to call the pediatrician (and when to go in)Baby Basics
What mothers here say about acute bilirubin encephalopathy
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Sources
- American Academy of Pediatrics — Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (Kemper and colleagues, 2022)