The best treatment for high bilirubin depends on the underlying cause.
Treating High Bilirubin in Adults
Moderately high bilirubin levels, such as those below 4 mg/dL, don’t typically require treatment. Doctors will typically begin intervening when your levels are at or above 4 mg/dL. At this point, addressing underlying conditions, such as liver disease, can typically treat the root cause of high bilirubin.
Treating High Bilirubin in Infants
Keeping the infant hydrated, particularly if elevated bilirubin is caused by dehydration, can help treat high bilirubin. This can involve supplementing breast milk with bottle feeding or administering intravenous fluids. “Depending on where you are in the country, that can even be done at home, but in some places, that needs to happen in the hospital,” Guttman says. “Those are our first line interventions and for the vast majority of infants, that is enough.”
“IVIG can be helpful because it helps address the immunologic issue that is causing them to break down the red blood cells; that’s a limited number of patients, but it can be helpful for some babies,” Guttman says.
In extreme cases, in which levels are getting very high or the first lines of treatment are not working, a baby may need an exchange transfusion. This involves removing the baby’s blood and replacing it with a donor’s blood. “Most of the time we are able to manage with more conservative measures,” Guttman says.
High bilirubin levels do not cause long-term issues in the vast majority of infants. However, untreated severely high bilirubin levels can cause brain damage, hearing loss, and cerebral palsy. “It is exceedingly rare these days that it hits these levels because this is a very well-understood phenomenon,” Guttman says. “We are, at all costs, avoiding the levels getting to the point where it would cause that.”
