When bilirubin goes bad

Some research seems to suggest that bilirubin, a waste by-product of the death of red blood cells, can play a beneficial role in the body. But mostly, too much is definitely a bad thing.

As was the case with Guinness, Innaias has a concentration of bilirubin that could be dangerous, or even fatal, if left untreated. A positive Coombs test confirms that he has antibodies in his blood that target his own blood cells.

Guinness never had a Coombs test (that we can recall), but it’s very likely that his blood would have tested positive as well. In both cases, the source of the antibodies would be Debra, which her body started producing after being exposed to Flynn’s blood during his delivery, and which she then subsequently shared with Guinness and Innaias during their fetal development.

The result is antibodies in the blood that hasten the destruction of red blood cells. Newborns often wind up with high bilirubin levels anyway, because of immature livers and a relative excess of red blood cells, but normally these factors are short-lived and bilirubin levels reduce naturally on their own before getting dangerous.

In this case, with the blood incompatibility, bilirubin production is much higher, and goes on for much longer, and so treatment is imperative lest the bilirubin build up to levels high enough to cause serious, permanent harm. In the worst cases, an “exchange transfusion” is used to completely replace the antibody-laden blood. Fortunately, our own situation calls for something less drastic: phototherapy.

The best equipment is found at the hospital, of course. But adequate results can be obtained with at-home care, using borrowed lights (links go to photos from Guinness’s treatment when he was born). This does mean that we get to spend very little time holding our newborn, but at least we’re at home, and generally the therapy is required for only a short time (we will likely be done within 7-10 days after Innaias’s birth, which is when the bilirubin level is likely to start going down on its own).

Of course, this also means that visitors won’t get to interact with Innaias much, if at all. We’re home and don’t mind if you want to come over to see us, but you may prefer to wait until Innaias is done with his phototherapy. Keep an eye on his main page for his current status.

August 12th: Innaias has been off of phototherapy since the afternoon of the 10th. The blood test taken today shows “direct” bilirubin at zero. The “total” bilirubin level is still somewhat high at 14 or so, but the pediatrician says that with the direct at zero, he’s not worried about the total being a bit high. We’ll keep an eye on him and make sure he continues to improve, but for now he seems to be doing fine. It’s very nice to have him no longer stuck in his bassinet all the time!