Bilirubin Levels – What’s Normal And What’s Not

Bilirubin Levels – What’s Normal And What’s Not

It’s estimated that 60% of full term and 80% of premature babies develop jaundice (hyperbilirubinaemia) in the first week after birth.

Jaundice occurs when red blood cells are broken down, and the byproduct of this process (bilirubin) is not excreted from the body fast enough and builds up.

In most cases jaundice is harmless and disappears without treatment after a few weeks.

A few babies can become severely jaundiced, and need investigation and treatment to prevent possible serious complications from developing.

To understand newborn jaundice, firstly, it’s important to know there are different forms of jaundice.

Here are three types of jaundice seen in newborns:

  • Physiological Jaundice: occurs due to high concentration of red blood cells and immature liver function, usually appears 2-4 days after birth and resolves in 1-2 weeks (3 weeks if premature). It is not associated with underlying disease or disorders.
  • Pathological jaundice: is always considered if jaundice develops in the first 24 hours after birth, or if levels are very high from 24 hours to 10 days of age, or the baby shows signs of serious illness.
  • Breast milk jaundice: occurs 5-7 days after birth, typically peaks at 14 days and can last as long as a few months. It’s thought to be caused by an increased concentration of an enzyme (β-glucuronidase) in breast milk. Breast milk jaundice is common in breastfed babies and is physiologically normal and nothing to worry about.

What Are Normal Bilirubin Levels?

It’s normal to have some bilirubin in your blood. Older children and adults should have bilirubin levels at or below 1mg/dL (milligrams per deciliter).

Almost all babies have increased bilirubin levels within 1-2 days of birth. Newborn jaundice (neonatal hyperbilirubinaemia) is diagnosed when blood levels of bilirubin are over 5mg/dL.

The below bilirubin levels are acording to the American Academy of Family Physicians:

  • Physiological jaundice in healthy term babies usually sees bilirubin levels of about 5-6mg/dL on day 4 after birth, then dropping over the next week until reaching normal levels.
  • Breastfed babies are more likely than formula fed babies to develop moderate jaundice with levels up to 12 mg/dL. This is called breast milk jaundice and is considered to be an extended form physiological jaundice.
  • Newborns with multiple risk factors may also develop an exaggerated form of physiological jaundice, with bilirubin levels as high as 17mg/dL.
  • Around 30% of healthy breastfed babies will develop breast milk jaundice. This usually begins around 5 days after birth and levels are between 12-20mg/dL. Levels usually begin to fall around 2 weeks after birth but around 10% of babies have elevated levels at one month post birth and it may last until 12 weeks.
  • Pathological jaundice is marked by the appearance of jaundice within 24 hours after birth, a rising bilirubin level of more than 5mg/dL per day, and a bilirubin level higher than 17 mg/dL in a full term newborn. There are a number of disorders that cause pathological jaundice such as biliary atresia.
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What Do Abnormal Test Results Mean?

While it’s very common for bilirubin levels to be elevated in newborns for the first few days of life, if levels are 20mg/dL or more, severe hyperbilirubinemia is diagnosed. Less than 2% of babies will develop severe hyperbilirubinemia. The main factors that your baby’s doctor will consider are:

  • How old your baby is (how many hours/days after birth jaundice develops)
  • How fast the level is rising
  • Whether your baby was born early (premature).

There are two forms of bilirubin can be measured by laboratory tests and can help determine the cause and treatment for hyperbilirubinemia:

  • Indirect or unconjugated bilirubin – when red blood cells are broken down, bilirubin is formed and is carried by proteins to the liver. Small amounts may be present in the blood.
  • Direct or conjugated bilirubin – is formed in the liver when bilirubin combines with sugars (conjugated), enters the bile and is eventually eliminated by the stool. Under normal conditions conjugated bilirubin is not present in the blood.

In rare cases high levels of unconjugated bilirubin can be toxic and damage developing brain cells, leading to a type of brain damage called kernicterus.

Full term babies who have risk factors and premature babies can develop kernicterus at lower levels of bilirubin than healthy full term babies. Long-term effects of kernicterus are learning and developmental disabilities, hearing loss, movement problems, eye movement problems, and death.

The exact level that is linked to kernicterus in a healthy full term newborn is not known and the occurrence is rare – developing in 1:100,000 babies. There are a number of factors which influence toxicity of the brain, such as ethnicity, underlying disease, and how old the baby is.

When Is Treatment Necessary?

If your baby is thought to have jaundice, it may be recommended to test bilirubin levels. There are two ways to test:

  • Bilirubinometer: a device which beams light onto your baby’s skin. The meter analyses how the beams of light are reflected off the skin, or absorbed by the skin, then calculates the level of bilirubin in the blood.
  • Blood or serum test: a sample of blood that is usually obtained by pricking your baby’s heel with a needle. The level of bilirubin in the liquid part of the blood (the serum) is measured, and the types of bilirubin that are elevated.

Treatment is recommended if bilirubin levels reach:

  • 15mg/dL in newborns 25-48 hours old
  • 18 mg/dL in newborns 49-72 hours old
  • 20 mg/dL in newborns older than 72 hours

Phototherapy is a very effective treatment for hyperbilirubinemia and is used widely. The therapy dosage varies depending on gender, gestational age and time since birth. Depending on where you live and your baby’s risk level phototherapy in your home may be an option. If you’re baby’s risk level is high, hospital admission for phototherapy is usually necessary.

Newborn jaundice is common and rarely poses a health risk to your baby. However, if jaundice does occur it’s important to monitor it. Find out more about newborn jaundice.

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Sam McCulloch enjoyed talking so much about birth she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she writes novels. She is mother to three beautiful little humans.


    1. At that level I was told by a nurse 15 minutes of indirect sunlight (like at a window) a few times a day! Always consult a physician!

  1. my brothers boy baby born three days before . His jaundice level is increasing today from 16 to 19 . what are treatments we need to take further .
    please advice .

  2. My baby was born with 0 bilirubin and the nurses told us that they had never seen that before. I googled it and cannot find any information on babies born without bilirubin. Is it really that uncommon?

  3. Hello- My baby is 6 days old and has a bilirubin level of 22 —she has been kept under photo therapy treatment and how soon would she get recovered- is it complicated then upto what level…

    She has not been injected with Hepatitis and other form of life long one time injections due to jaundice infected in here body- please suggest ASAP…

  4. My Baby is Day 27 now and my hospital reading is showing different way. That is 234. Please advise. My report of Liver Fuction Test can only be obtained next Monday and I’m starting to worry should I consult another hospital which can get my report faster?

  5. My baby is 7 days old and diagnosed jaundice on 3rd day. He is under phototherapy now. His levels were 11.2mg/dl, 18.64mg/dl, 12.2mg/dl, 19.6mg/dle, 17.5mg/dl, 13.5mg/dl each day respectively. So how long he should be under phototherapy treatment? His feeding is also in a lesser amount.

  6. My baby is 44days old and he is having bilirubin levels as mentioned below
    0.5 direct
    5.4 indirect
    5.9 total
    When he was 30days old he had bilirubin levels as mentioned below
    0.1 direct
    6.6 indirect
    6.7 total

    Is it safe for the baby? If not what kind of diagnosis is required? Please let me know.
    Thank you.

  7. My sistrs baby is 27days old & his bilirubin levels are mentioned below
    Serum bilirubin -8.0mg/dl
    Unconjugated(I.D) -5.0mg/dl
    Conjugated(D.bilirubin) – 3.0mg/dl
    Is this range safe for baby? plz….. let me know about dis

  8. Hello,our baby girl left hospital after 2 days under the lights was there extra fivr days . She is now 3 weeks old level was 16.1 .she is breastfed. And has not gained any weight since birth at 6.6 . Now is at 6.5 . She was born at 37+5 days . Also being checked for milk alergy .
    Really worried is this common or is there another problem

    TOTAL 7.29 mg%
    DIRECT 1.24 mg%
    CREATININE 0.7 mg %
    Is it safe for the baby? If not what kind of diagnosis is required? Please let me know.
    thank you

  10. My daughter is 14 days old and her total bilirubin level is 17.36. Is it normal . My ped give her phototherapy while she was 3 days old while her total bilirubin level is 15.79 for 2 days.. again we readmite her while total bilirubin level is 17.22 on her 8th day. After 28 hours phototherapy her total bilirubin level goes down 14.97.

  11. My baby is 7 days old she had developed jaundice symptoms after 24 hrs of the birth, initially total bilirubin concentration was 34, after admission in child care hospital and phototherapy one day treatment it has lower down to 21 now after 4th day slightly level was increased to 23 and from there up to 7 day same results are coming out after lab test.
    Serum bili total : 23. 4mg%
    Serum bili direct : 2.3 mg%
    Serum bili indirect : 21.1mg%
    Plz suggest she is under phototherapy treatment and there is no change in report.
    What will be the reason. And plz suggest my baby is safe.
    Note: phsically her skin has became clear (discolouration of yellow pigments)
    And she is active, as per. Dr. Suggestion the corelation between baby’s condition. And lab reports are not matching what will be the probable reason.

    PLz suggest I am in trouble and comments.
    Thank you.

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