How Fast Does the BiliBlanket Work? Not Fast Enough!

What is a BiliBlanket and how fast does it work?  The BiliBlanket is a special light vest that newborns wear 24 hours a day if their bilirubin levels get too high.  Somehow, it accelerates the elimination of bilirubin from the baby's body.  In the old days, you just stuck an orange baby in the windowsill.  These days, you order a BiliBlanket and have a home health care nurse come out every day for a weight check and bilirubin level.    Thinking back to my medical school days, bilirubin is a byproduct of metabolism from the breakdown of hemoglobin.  It is metabolized in the liver and can be excreted through stool (as direct bilirubin) or water soluble indirect bilirubin (peeing it out).

Jaundice of the newborn is very common.  Often the jaundice (the orange color as a result of a build up of bilirubin in the body) resolves on its own as the newborn baby's immature liver catches up with the metabolism.   End stage alcoholics turn orange because their liver is incapable of metabolizing bilirubin and their levels rise in the blood stream and eventually show up in the skin as the color orange.  That's why cirrhotic patients are given lactulose.  It helps them poop out their hepatic toxins when they get encephalopathic.  It's the same concept for jaundice of the newborn.

But why do babies get jaundiced after a couple of days?  Bilirubin is eliminated by stool and urine.  Often premature babies are too weak to maintain a stable and rising weight and are unable to keep ahead of the bilirubin elimination needs.  So being an underweight or premature baby is a risk factor. So is bruising.   Our Zachary had  a big bruise.  Mrs Happy pushed him out in the occiput-posterior (OP) position, without an epidural on his head. Yikes! His blood resorption couldn't be  handled by his immature liver while trying to metabolize the breakdown of  fetal hemoglobin that kept him going inutero.

Often, as is the  case with Zachary, with an elevated bilirubin, the newborn will fall asleep at the breast and will be unable to maintain a stable and rising weight.  In the case of Zachary, that meant we continued to finger feed him.    Mrs. Happy gave him ten minutes on each breast and then cut him off to prevent him from expending unnecessary calories in a diminishing return of calories to effort ratio.  Then she pumped for an additional ten minutes while I fed him 30 cc (one ounce) of her previously pumped milk with my finger in his mouth to simulate a nipple.

Here he was just under  seven days old.  His April 21st, birth weight of six pounds twelve ounces bottomed out at six pounds, two ounces, a drop of nine percent.  He has now gained 4.5 ounces in the last three days.  His BiliBlanket was started Tuesday, April 26th at a bilirubin level of 17.4 after an April 25th level of 16.5.  What's dangerous about bilirubin?  If the levels get too high, bilirubinemia can cause long term central nervous system damage called kernicterus. Our levels dropped steadily over three days.  Was it due to the BiliBlanket or just a maturing liver?  Who knows.  I do know that Blue Cross Blue Shield pays for a home health care nurse and the BiliBlanket therapy and daily lab draws. 

After three days of being tied to an electrical outlet for 24 hour BiliBlanket jaundice therapy, Zachary's level dropped from 17.5 to 14. 5 to 12.5 and he was  free to roam around the home  I felt like we were running a make shift hospital at our home. Here's a picture of the home health care nurse getting the bilirubin sample from a heel stick.   All things considered, we have a health baby boy with ten fingers and ten toes and he's so dog-gone cute.  I feel great empathy for the parents who feel trapped by their newborn's illness that prevents them from being free.  You can watch Zachary grow up here.  

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--> Did you know elevated bilirubin is not a codeable diagnosis but hyperbilirubinemia is. Try writing that dozens of times a day. And this is just one example of hundreds. It's sad to say but elevated bili communicates clearly the problem among doctors. But we don't document for other doctors. We are required to document for coders so everyone gets paid.  Just one more example of how these behind the scene time consuming requirements take away from your face to face time as a patient.

I wonder if I misspelled hyperbilirubinemia if coders would allow it or if they would require clarification!

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