What Are Bilirubin Levels?

In adults, high levels may indicate a benign genetic disorder, such as Gilbert syndrome, or an underlying issue with your liver. Elevated bilirubin in infants is quite common and may be caused by dehydration or preterm birth. High bilirubin levels are often treatable in adults and infants.

Your bilirubin level can indicate how well your liver and other bodily processes are functioning.

Bilirubin is a yellow substance and is responsible for giving bile and your stool its color. In a healthy body, the liver gets rid of bilirubin by using it to create bile, a fluid that aids digestion in the intestines. When bilirubin builds up, it can cause the skin and the whites of your eyes to turn yellow, and your stool may appear light- or clay-colored.

Jaundice may present when your bilirubin levels reach about 3 mg/dL, but you can start seeing changes in the color of the whites of your eyes when levels reach about 2 mg/dL, says Karl Kwok, MD, a gastroenterologist with Kaiser Permanente Southern California in Los Angeles. Elevated bilirubin levels, ranging from 1 to 4 mg/dL, typically don't require treatment.

“The story we hear, not uncommonly, is that someone has a big event coming up like a final exam or a big work presentation, and they notice the whites of their eyes appear a bit yellow,” says Dr. Kwok, which prompts testing, a diagnosis, and treatment.

In adults, very high levels start around 4 mg/dL which is when doctors typically start intervening, Kwok says. At this level, you may experience even more noticeable skin discoloration, as well as itching and fatigue.

Elevated bilirubin levels are much more common in newborns than in adults, especially those born prematurely. In newborns, normal bilirubin levels typically range between 1 and 12 mg/dL.

The key indicator of elevated bilirubin in adults and infants is jaundice, which usually affects the whites of the eyes first. “The whites of the eyes or skin can turn temporarily yellow. That, in essence, is a check engine light. It alerts the person that hey, perhaps I should look into this,” says Kwok.

Symptoms of High Bilirubin in Adults

• Jaundice
• Frequently itchy skin
• Dark-colored urine or light-colored stool
• Bloating
• Pain in the abdomen
• Swelling in the ankles and legs
• Nausea and vomiting
• Lack of appetite
• Fatigue
• Weakness

Symptoms of High Bilirubin in Infants

• Jaundice
• Not feeding well
• Being sleepier than normal
• Dark yellow urine (it should be colorless)
• Have pale stool (it should be yellow or orange)
• Dehydration

In addition, infants may experience dehydration, Guttman says. This can cause infants to urinate less.

High levels occur when your body isn't able to get rid of bilirubin and it builds up in the blood. The causes are notably different for adults and infants.

High Bilirubin in Adults

• Liver diseases, such as hepatitis and cirrhosis
• Hemolytic anemia, when blood cells are destroyed prematurely
• Bile duct obstructions, usually from a gallstone, but sometimes from a tumor

High bilirubin levels may also be the result of certain genetic disorders, including:

• Gilbert Syndrome This is a common condition where the liver doesn't process bilirubin as it should. It's harmless and doesn't require treatment.

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• Dubin‐Johnson Syndrome This is a rare and benign lifelong condition that doesn't require treatment. Bilirubin collects in the liver and bloodstream rather than moving out of the digestive system. It causes the liver to turn black.

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• Crigler-Najjar Syndrome This is a very rare congenital condition, occurring in 0.6 to 1 in 1 million newborns in the world. If not treated, it can lead to significant brain damage.

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High Bilirubin in Infants

It isn't uncommon or much cause for worry if a newborn baby has elevated bilirubin levels within the first two to three weeks of life, says Dr. Guttman. In fact, about 60 percent of full-term infants and 80 percent of premature infants develop jaundice in the first week after birth.

Newborns have increased production of bilirubin because their hemoglobin, a protein found in red blood cells, turns over more quickly. At the same time, they're not able to clear bilirubin as well as adults. Newborns also take in more bilirubin from the intestine and pull it back into circulation.

Within those first couple of weeks, high bilirubin, which causes jaundice, is very treatable and likely not a sign of a long-term problem. In these cases, it may be caused by dehydration or breast milk jaundice.

• A biliary flow obstruction, such as a cyst
• Genetic causes, such as Dubin-Johnson syndrome
• Down syndrome
• Infections such as syphilis, HIV, or herpes

If you're experiencing symptoms and a doctor suspects that you may have elevated or high bilirubin levels, they may conduct a blood or urine test.

“Routine lab testing can usually get to the heart of the matter pretty quickly,” says Kwok. “Very high bilirubin levels can affect the nervous system in adults. The primary goal there is to see what is going on in the liver so we can prevent ongoing health issues.”

Bilirubin Blood Test

A blood test is most commonly used to detect elevated or high bilirubin. This test can be done in both adults and infants to measure the specific amount of bilirubin circulating in the blood.

Before taking a blood test, you may need to fast or stop taking certain medications for accurate results. If your blood test shows elevated or high bilirubin levels, your doctor will likely order additional tests, such as a liver panel, biopsy, urine test, or ultrasound, to determine the underlying cause.

Bilirubin Urine Test

A bilirubin urine test is typically part of a broader urinalysis that checks the overall health of your urinary tract and is done using a simple urine sample. Usually, there isn't any bilirubin in urine.

If your doctor is concerned about your high bilirubin levels, they may order a liver panel. Seeing a breakdown of conjugated and unconjugated bilirubin levels on this panel can help doctors narrow down the potential underlying cause, Kwok says.

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.”

It's not always possible to prevent high bilirubin in infants or adults, but there are a few ways to lower the risk.

How to Prevent High Bilirubin in Adults

In general, people can prevent high bilirubin levels by addressing its underlying causes, such as obstructions or liver disease.

In people who have Gilbert syndrome, excessive stress and dehydration can trigger high bilirubin, says Kwok. Managing stress may help keep bilirubin levels down.

How to Prevent High Bilirubin in Infants

High bilirubin is very common in infants and not often preventable, Guttman says.

Preventing dehydration can decrease an infant's risk of high bilirubin, too. Keep an eye on how often your infant urinates. In the first 24 hours, a diaper may only be wet two or three times. After that, a newborn baby's diaper should be wet almost every time you check it, Guttman says.

"Once a baby comes home, you certainly want to make sure they are urinating regularly," she says. "Talk to your pediatrician if you are concerned your baby isn't getting enough. You can supplement even temporarily with formula or meet with a lactation consultant to try to remedy dehydration."

• Bilirubin is a waste product that is processed by the liver and gives bile its yellow hue. While low bilirubin levels aren't a cause for concern, high levels can lead to jaundice.
• High bilirubin levels are common in infants. They're usually not a cause for concern as long as they're evaluated by a doctor.
• In adults, high bilirubin levels are less common and could be due to any number of conditions. These include benign ones that require no treatment, such as Gilbert syndrome, and other more serious medical conditions, such as liver disease or bile duct obstruction.
• High bilirubin levels are often very treatable in both infants and adults, though in some cases, they can be a sign of a more serious underlying condition.