Jaundice stool color chart. Baby Poop Color Chart: Understanding Infant Stool Changes and Health Indicators

20.09.202324.06.2023 by alexxlab

What do different baby poop colors mean. How can stool changes indicate a baby’s health status. When should parents be concerned about their infant’s bowel movements. What are normal and abnormal baby poop colors and textures.

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The Rainbow of Baby Poop: Decoding Infant Stool Colors

Navigating the world of infant care can be daunting, especially when it comes to understanding what’s normal in your baby’s diaper. One of the most common concerns for new parents is the color and consistency of their baby’s poop. Let’s dive into the colorful world of infant stool and what it might indicate about your little one’s health.

Black Stools: Normal for Newborns, Concerning for Older Infants

In the first week of life, black stool is perfectly normal. This thick, tar-like substance is called meconium and consists of cells, amniotic fluid, bile, and mucus ingested by the baby while in the womb. Meconium is typically odorless due to its sterile nature.

Why does meconium appear black? The color is due to the concentration of substances accumulated during fetal development. As the baby begins to feed, the stool color should gradually transition from black to dark green, and finally to yellow.

However, if black stools persist beyond the first week of life, it’s crucial to seek medical advice. Persistent black stools in older infants could indicate bleeding in the upper digestive tract, which requires immediate attention.

Yellow Stools: The Hallmark of Breastfed Babies

For breastfed infants, yellow is the gold standard of poop colors. This mustard-like hue is often accompanied by small flecks, giving it a “seedy” appearance. These seeds are actually undigested milk fat and are completely harmless.

Why is breastfed baby poop yellow? The color comes from the breakdown of bile in breast milk. The seedy texture is due to the high fat content in breast milk, which is essential for a baby’s rapid growth and brain development.

Brown or Orange Stools: Typical for Formula-Fed Infants

If your baby is formula-fed, you’re likely to see light brown or orange stools. These tend to be slightly darker and firmer than those of breastfed babies.

Why do formula-fed babies have brown poop? The color difference is due to the composition of formula, which contains different proteins and fats compared to breast milk. The iron content in formula can also contribute to the darker color.

Green Baby Poop: When to Worry and When It’s Normal

Green stools are common in infants and can have various causes. In many cases, occasional green poop is no cause for concern, especially if your baby is growing well and seems content.

Common Causes of Green Baby Poop

Slow digestion, often due to overfeeding
Green foods in the breastfeeding mother’s diet
Minor illnesses like colds or stomach bugs
Food allergies or intolerances
Antibiotics (taken by the baby or the breastfeeding mother)
Treatment for jaundice

Is green poop always a sign of illness in babies? Not necessarily. Some infants naturally have slightly green stools. However, if green poop is accompanied by other symptoms like fussiness, poor feeding, or fever, it’s best to consult a pediatrician.

Red Flag: Understanding Red Baby Poop

Red is not a healthy color for baby poop and usually indicates the presence of blood. While this can be alarming, it’s important to stay calm and seek medical advice promptly.

Potential Causes of Red Baby Poop

Swallowed blood from cracked nipples during breastfeeding
Anal fissures or small tears in the rectum
Intestinal infections
Food allergies
In rare cases, more serious digestive issues

Can red poop ever be harmless in babies? While it’s always best to consult a doctor, occasionally red poop can be caused by certain foods or medications. However, it’s crucial not to assume this and to seek medical advice to rule out any serious conditions.

White Baby Poop: A Potential Sign of Liver Issues

White or very pale stools in infants are uncommon and could indicate a problem with the liver or bile ducts. This color change is particularly concerning if it persists for more than one or two stools.

Jaundice and White Stools

Jaundice, a condition causing yellowing of the skin and eyes, is common in newborns. While it usually resolves within two weeks, persistent jaundice accompanied by pale or white stools may suggest a more serious liver problem.

How can parents distinguish between normal and problematic jaundice? If jaundice persists beyond 14 days, or if it’s accompanied by white stools and very dark urine, it’s crucial to consult a pediatrician. They may perform tests to check bilirubin levels and liver function.

Texture Matters: Understanding Baby Poop Consistency

The texture of your baby’s poop can be just as informative as its color. Before starting solid foods, infant stools are typically very soft.

Breastfed vs. Formula-Fed Baby Poop Texture

Breastfed babies often have runny or stringy stools, while formula-fed infants tend to have firmer, but not solid, poop. Mucus in the stool is also common and usually not a cause for concern.

What does it mean if a baby’s poop is too hard or too soft? Dry or hard stools could indicate dehydration or constipation, while very watery stools might signal diarrhea. Both conditions require attention, especially in young infants who can quickly become dehydrated.

Frequency of Bowel Movements: What’s Normal for Babies?

The frequency of bowel movements can vary greatly among babies. Newborns often poop after each feeding, but this typically decreases as they grow older.

Bowel Movement Patterns in Infants

Newborns: 3-4 times per day or more
1-3 months: 2-3 times per day
3-6 months: 1-2 times per day
6+ months: Once daily or every other day

Is it normal for a baby to go a day without pooping? For older infants, especially those over 6 months, it can be normal to go a day or two without a bowel movement. However, if this is accompanied by discomfort or a change in eating habits, it’s worth discussing with a pediatrician.

When to Seek Medical Advice: Red Flags in Baby Poop

While many changes in baby poop are normal, certain signs warrant immediate medical attention:

Persistent black stools after the first week of life
Red or bloody stools
White or very pale stools
Persistent diarrhea or signs of dehydration
Hard, pebble-like stools indicating severe constipation
Significant changes in stool consistency or frequency accompanied by other symptoms like fever, vomiting, or lethargy

How quickly should parents seek medical advice for concerning stool changes? For any of the above symptoms, it’s best to contact your pediatrician within 24 hours or sooner if the baby appears ill or uncomfortable.

Dietary Influences on Baby Poop

As babies grow and their diets change, so does their poop. The introduction of solid foods can significantly alter the color, consistency, and frequency of bowel movements.

Impact of Solid Foods on Baby Poop

When babies start eating solid foods, parents might notice:

Changes in stool color (e.g., green poop after eating spinach)
Firmer, more formed stools
Noticeable food particles in the stool
Stronger odor
Less frequent bowel movements

How long does it take for a baby’s digestive system to adjust to new foods? It can take several days to a few weeks for a baby’s digestive system to fully adapt to new foods. During this time, temporary changes in stool color and consistency are normal.

Food Allergies and Baby Poop

Introducing new foods can sometimes reveal food allergies or intolerances. Signs to watch for include:

Mucus-like stools
Blood in the stool
Diarrhea
Constipation
Rashes or other allergy symptoms

What should parents do if they suspect a food allergy? If you notice any of these signs after introducing a new food, stop giving that food and consult your pediatrician. They may recommend an elimination diet or allergy testing.

The Role of Hydration in Baby Poop

Proper hydration is crucial for maintaining healthy bowel movements in infants. Dehydration can lead to constipation and other health issues.

Signs of Dehydration in Baby Poop

Dry, hard, pebble-like stools
Less frequent bowel movements
Dark-colored urine
Dry mouth and fewer wet diapers

How can parents ensure their baby stays hydrated? For breastfed babies, frequent nursing is usually sufficient. Formula-fed babies may need additional water, especially in hot weather or during illness. Always consult your pediatrician before giving water to babies under 6 months old.

Probiotics and Baby Gut Health

Probiotics have gained attention for their potential benefits in infant gut health. These beneficial bacteria can help maintain a healthy digestive system and may influence stool characteristics.

Potential Benefits of Probiotics for Babies

Reduced incidence of colic
Improved digestion
Possible reduction in constipation or diarrhea
Enhanced immune function

Are probiotics safe for all infants? While generally considered safe, it’s important to consult with a pediatrician before starting any probiotic regimen, especially for premature babies or those with compromised immune systems.

Tracking Baby’s Bowel Movements: Tips for Parents

Keeping track of your baby’s bowel movements can provide valuable information for both parents and pediatricians. Here are some tips for effective tracking:

Use a dedicated app or journal to record frequency, color, and consistency
Note any changes in diet or routine that might affect bowel movements
Take photos if you’re concerned about a particular stool (for showing to the doctor)
Record any accompanying symptoms like fever, fussiness, or changes in appetite
Keep track of wet diapers to monitor hydration

How long should parents track their baby’s bowel movements? It’s particularly useful to track during the first few months of life and during any dietary transitions. However, if you have ongoing concerns, continued tracking can be helpful for discussing patterns with your pediatrician.

Common Myths About Baby Poop Debunked

There are many misconceptions about baby poop that can cause unnecessary worry for parents. Let’s address some common myths:

Myth 1: Green poop always indicates a problem

Reality: Occasional green stools are often normal and can be caused by various factors, including diet and digestion speed.

Myth 2: Babies should have a bowel movement every day

Reality: The frequency of bowel movements can vary greatly between babies and can change as they grow.

Myth 3: Breastfed babies don’t get constipated

Reality: While less common, breastfed babies can still experience constipation, especially during dietary changes.

Myth 4: Solid food will immediately change a baby’s poop

Reality: It can take time for a baby’s digestive system to adjust to solid foods, and changes in stool may be gradual.

Why is it important to dispel these myths? Understanding what’s truly normal can help parents avoid unnecessary anxiety and know when to seek medical advice.

The Bottom Line on Baby’s Bottom: Key Takeaways

Understanding your baby’s poop can provide valuable insights into their health and development. Here are the key points to remember:

A wide range of colors and consistencies can be normal, depending on age and diet
Red, white, or persistently black stools warrant medical attention
Changes in diet, including the introduction of solid foods, can affect stool characteristics
Hydration plays a crucial role in maintaining healthy bowel movements
When in doubt, consult your pediatrician â€“ they’re there to help and provide peace of mind

By staying informed and attentive, parents can use diaper changes as an opportunity to monitor their baby’s health and ensure they’re thriving. Remember, every baby is unique, and what’s normal can vary. Trust your instincts, and don’t hesitate to seek professional advice when needed.

What does baby poop color mean? Chart and guide

An infant’s poop changes color and consistency during their first few days, weeks, and months of life, and a wide range of colors is normal. Below, learn how to recognize unhealthy baby poop and what to do if it happens.

In infants, the main reasons for changes in stool color are age, diet, and health. The poop of newborns is almost black, while older infants tend to have yellow or brown poop.

Breast milk and formula can also influence the color of a baby’s stools.

Red or white poop can indicate a health problem. Otherwise, a wide range of colors is normal. Anyone who suspects that a baby has diarrhea or constipation should seek medical advice.

Various factors can cause changes in the color of a baby’s stools. Common colors and their causes include:

Black

In newborns younger than 1 week, black is a healthy color for stool. After this time, however, it could indicate a health problem.

During the first 24 hours of life, a newborn will pass meconium. This is thick, black stool. It comprises cells, amniotic fluid, bile, and mucus that the baby ingested while in the womb. Meconium is sterile, so it usually does not smell.

Over the first few days of life, a newborn will continue to pass meconium. The color should gradually change from black to dark green, then yellow.

After 1 week of life, stool should no longer be black. If a black color persists, it is important to seek medical advice. This color could mean that there is some bleeding in the digestive system.

Yellow

This is a normal color of poop from a baby who drinks breast milk. Their poop tends to be dark yellow, and it may have small flecks in it.

These flecks come from breast milk and are harmless. People often describe this poop as “seedy.” The so-called seeds may resemble curds in cottage cheese, but they are yellow.

Brown or orange

This is a normal color of poop from a formula-fed baby.

When a baby drinks formula, their poop tends to be light brown or orange. It may be slightly darker and firmer than stool from a baby who drinks breast milk.

Green

Many babies occasionally have green poop. Possible causes include:

slow digestion, usually because the baby has eaten more than usual
green foods in the diet of the person producing breast milk
a cold or stomach bug
a food allergy or intolerance
antibiotics, either in the baby or in the person producing breast milk
treatment for jaundice

Some infants’ poop is naturally slightly green. If the baby is putting on weight and seems content, green poop is not necessarily a cause for concern.

Learn more about green poop in children.

Red

Red is not a healthy poop color.

Poop is usually red because there is blood in it. Parents or caregivers should seek medical advice as soon as possible.

The baby may have a health problem, or they may have swallowed a small amount of blood. This could happen if the person breastfeeding them has cracked or bleeding nipples. Another cause of red poop is bleeding from the baby’s bottom.

White

White poop is uncommon, but white is not a healthy color for stool. It could indicate a liver problem.

Jaundice, for example, is highly common in newborns, affecting about 60% of full-term babies in their first few days of life. It usually goes away within the first 2 weeks.

Anyone who suspects that their baby still has jaundice after 14 days should check the color of their poop. Pale or white poop may suggest liver disease. Another sign to look for is urine that is very dark yellow or brown.

If the baby has white or pale stool, the doctor may test their bilirubin levels. Bilirubin is a compound that helps the body get rid of waste. There are two types of bilirubin, and if the levels of one type are too high, this can cause health problems.

Baby poop can also have a variety of textures and other features. Before an infant starts eating solid food, their poop is usually very soft.

Babies who drink breast milk may have quite runny or stringy poop, while formula-fed babies tend to have firmer, but not solid, poop.

Mucus in a baby’s stool is also common and rarely a sign of any health issue. However, if the baby shows other signs of unusual behavior or illness, it is important to speak with a doctor.

Dry or hard poop can mean that a baby is not drinking enough fluids or that they are ill.

After an infant starts to eat solid foods, hard poop can also be a sign of constipation. Babies commonly become constipated when they eat foods that their body cannot yet digest properly.

Very watery stool can result from diarrhea. A baby with diarrhea may also poop more often than usual or have a high temperature. Diarrhea can cause dehydration, which is potentially serious for infants.

Every baby is different, and some poop more often than others. Many newborns poop after each feeding, though they tend to pass stool less frequently once they reach 6 weeks of age. Babies who drink breast milk may only poop once a week. A healthy frequency for formula-fed babies is once per day.

Learn more about constipation in babies.

As a baby grows, their poop often changes color. For example, as an infant starts to eat solid foods, what they eat may affect the color of their poop. Undigested food in stool can also cause a change in color.

Unusual colors, such as green, may not signal a health issue. Stool color may vary for a short time and then return to its regular shade.

White, red, or black are the exceptions — these colors can indicate a health problem.

Also, if a lot of mucus is present or it appears in stool on an ongoing basis, this could signal an illness.

Parents or caregivers should contact a doctor if they have any concerns regarding an infant’s health.

Newborns generally poop frequently, sometimes after every feed. Infants older than 3 weeks may poop anywhere between 8–12 times a day to less than once a day.

Healthy poop can be shades of yellow, orange, brown, or green, and the texture may be runny to fairly firm. It should not be hard or watery.

Babies often strain a little as they pass stool and may make noises or scrunch up their faces. This is normal. However, too much straining or discomfort when pooping could be a sign of constipation.

Poop color can be one way to keep track of a baby’s health.

Stool that is quite soft and earthy in color is generally healthy. However, red or white poop often signals a health issue that requires attention. Black stool from babies older than 1 week may also be a cause for concern.

Overall, as long as an infant is gaining weight and feeding as often as they need, a broad range of poop colors is healthy. Parents or caregivers should discuss any concerns with a doctor.

Baby Poop Color Chart – a Stool Type Guide by Similac®

Questions about your baby’s health? Her diaper may be full of answers.

If your baby seems fussy or sick, or if you simply aren’t sure if all is well, check her diaper for clues about what’s going on.

To begin, choose the stool below that looks most like your baby’s.

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Greenish-black and sticky baby poop

AKA: Meconium

Looks like: Licorice or tar

A thick, dark substance that fills your infant’s intestines before birth and is eliminated as stool after birth.

What does it mean?

Meconium stools are the first stools your baby will have after birth, and it is perfectly normal. It appears greenish-black because it contains bilirubin, a yellowish-green breakdown of red blood cells. The colostrum in your breast milk acts as a laxative and helps your baby pass the meconium in about 3 days.

What should I do?

There is no need to worry. This stool is normal, healthy, and temporary. (If it lasts more than 3 days, check with your doctor. He might want to check to make sure your baby is getting the feedings she needs to move this through her system.)

The information in this section was derived from the following:

Abbott Nutrition. Parents Guide to Infant Stools. March 2009.

McGrail A, Metland D, Murray L, et al. The BabyCenter Essential Guide to Your Baby’s First Year. July 2007.

Nathanson LW. The Portable Pediatrician. September 2002.

Yellow and seedy baby poop

AKA: Breastfed-baby poop

Looks like: Yellow, curdled milk

Your breastfed baby’s stools will look like this until you supplement with formula or begin feeding your baby solids.

What does it mean?

This stool is normal. Breastfed babies’ poop has a mild smell (and might come with loud sound effects).

What should I do?

Don’t worry. Your baby’s poop is standard. Breast milk has the ideal nutrients to help your baby stay healthy and grow strong.

Tan and thick baby poop

AKA: Formula-fed-baby poop

Looks like: Hummus

This is the result of feeding your baby formula, either as her full diet or as a supplement to breast milk.

What does it mean?

Your baby’s stools are normal. You should only be concerned if your baby’s poop is watery or becomes hard (especially small hard balls of stool).

What should I do?

There is no need to worry. Your baby’s stool is normal and healthy.

Greenish-brown baby poop

AKA: Introduction-to-solids baby poop

Looks like: Leftover guacamole

A mix of table foods, this poop is normal.

What does it mean?

Greenish-brown poop is typical and normal when your baby starts eating solids, but you might see this color in your baby’s diaper before then. If your baby has other symptoms that concern you, contact your healthcare professional.

What should I do?

Do not worry. This stool is normal and healthy.

Frequent watery, brown, and loose baby poop that is not typical for your baby

AKA: Diarrhea

Looks like: Watery with chunks

Frequent, loud, and loose stools could be diarrhea.

What does it mean?

The occasional loose baby stool is no cause for alarm. But if it occurs regularly for 2 days or more, it could be diarrhea. Diarrhea in babies can cause dehydration, and also might be a sign of infection. Usually these infections are not dangerous, but the dehydration that can result is a concern.

What should I do?

Call your healthcare provider if the problem persists for more than 2 days. The younger the baby, and the more frequent the diarrhea, the greater the concern for dehydration. Do not give your baby anti-diarrhea medication unless advised by your healthcare professional. Your healthcare provider might advise giving your baby an oral electrolyte solution, such as Pedialyte^®, to help prevent dehydration.

Contact your healthcare professional right away if you see:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Dry, brown, and hard baby poop

AKA: Constipation

Looks like: Dirt, clay, or pebbles

Hard, pellet-like stools could mean your baby is constipated.

What does it mean?

Occasional constipation is normal, especially with formula-fed babies and when your baby transitions to solid foods. It could be a sign that your baby is not getting enough fluid or that he is losing too much fluid from the heat, an illness, or a fever. Occasional blood streaking on the surface of the stool can result when hard stools make tiny tears in the soft tissues around the anus.

What should I do?

In a very young baby, consult your healthcare professional, who might recommend giving your baby small amounts of extra water. Give older babies plenty of breast milk or formula to drink. If your baby is eating solids, offer foods that are higher in fiber, such as fruit, vegetables, and whole grains, and add puréed prunes to your baby’s cereal. Check with your baby’s doctor about altering your baby’s diet or using juices.

Contact your healthcare professional right away if you see:

Blood or mucus in stools
Fever
Vomiting
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Pinkish-red baby poop

AKA: Artificially colored stools

Looks like: Partially digested food

What your baby eats comes out looking much the same as when it went in.

What does it mean?

Once your baby has started on solids, you will see bowel movements that can vary in color and texture after every meal. In addition to foods, some medications also can turn a baby’s poop unusual colors.

What should I do?

Watch what your baby eats to ensure there is a link between the color of the stool and what she is eating. Examples of foods known for turning baby poop shocking colors include carrots (orange) and spinach (green). If your baby’s stool is red for no apparent reason (no cherry Popsicle^®, Froot Loops^® cereal, or red gelatin), call your healthcare provider.

Contact your healthcare professional right away if you see:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Popsicle^® and Froot Loops^® are not registered trademarks of Abbott Laboratories.

Dark-green baby poop

AKA: Iron supplementation

Looks like: Thick, dark stool

If your baby’s stool is dark green, it could be the product of iron supplementation in your baby’s diet.

What does it mean?

In some babies, the iron sulfate in a supplement or iron-fortified baby formula can make dark-green stools, or sometimes even greenish-black. There is no need to be concerned with the color change, as it has no significance to your baby’s digestive system.

What should I do?

This stool is normal. Studies show that iron supplementation does not cause digestive problems or discomfort.

Contact your healthcare professional right away if you see:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Bright-green baby poop

AKA: Foremilk/hindmilk imbalance

Looks like: Green, frothy poop

Breastfed babies who get more foremilk than hindmilk sometimes have bright-green baby poop.

What does it mean?

When your breastfed baby nurses for short periods of time on each breast, he might get more foremilk, which is sweeter and thinner, and less hindmilk, which is richer and fattier. Your baby might need to nurse longer on each side in order to ensure enough hindmilk is consumed during each feeding.

Sometimes a virus will turn your baby’s stools bright green. If your baby is fussy and seems uncomfortable, contact your healthcare provider.

What should I do?

Try to let your baby empty the first breast before you switch to the other side.

Contact your healthcare professional right away if you see:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Red-streaked baby poop

AKA: Bloody stool

Looks like: A hard stool streaked with blood or mucus

Bright-red blood on a baby stool could indicate that your baby has small tears, or rectal fissures, around the anus.

What does it mean?

Often the stools of constipated babies are streaked with red from rectal fissures, small cracks in the anus caused by pushing. You also might see streaks of mucus on the baby poop.

What should I do?

If your baby’s doctor confirms the bleeding is from a fissure, there is little cause for concern. Usually, once the constipation has resolved, the bleeding stops. If there is a large amount of blood (more than a few drops) or if the bleeding does not resolve with the softening of the stools, check with your doctor.

If you notice any of the following symptoms, call your healthcare professional right away:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Black baby poop

AKA: Melena

Looks like: Black, thick, or tarry stool

Melena is a thick black stool that could contain blood that entered in the upper GI tract.

What does it mean?

A black baby stool might contain blood that entered the intestines in the upper portion of the digestive system.

What should I do?

If it’s not meconium (which passes during the first few days of life), call your healthcare professional immediately.

If you notice any of the following symptoms, call your healthcare professional right away:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

Chalky and white baby poop

AKA: Abnormal Stool

Looks like: Pale, colorless, or white stool

A chalky white baby stool could be a sign of a lack of bile, which normally turns a stool brown.

What does it mean?

A white stool might be a sign of a liver or gallbladder problem. Bile is a digestive fluid made in the liver and stored in the gallbladder. Your baby’s stool gets its normal color from the bile as it is excreted during digestion. If your baby’s liver doesn’t produce bile, or if the bile is obstructed, his stool will be white.

What should I do?

A white stool is very rare, but if your baby’s poop is white, call your healthcare professional right away.

If you notice any of the following symptoms, call your healthcare professional right away:

Blood or mucus in stools
Fever
Vomiting
Irritability
Refusal to eat
Decreased or dark-colored urine
Decreased activity

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What the level of bilirubin shows

More about the treatment of the disease: Hepatologist.

Article content:

How bilirubin is formed
Blood bilirubin level
- Bilirubin test: norm in an adult
- Norm in children
When is a bilirubin test ordered?
Advanced level
Symptoms of increased bilirubin
Reduced level

Bilirubin is a bright yellow pigment formed as a result of the breakdown of one of the most important blood proteins, hemoglobin. After the red blood cells, filled with hemoglobin and carrying oxygen, complete their life cycle, they are destroyed. The iron contained in hemoglobin goes to the needs of the body, and the rest is broken down, resulting in the formation of bilirubin. Part of the pigment is part of the bile, a certain amount is excreted with feces, converted into stercobilin, part – with urine in the form of urobilin.

The norm of bilirubin in the blood is determined, and it is separately calculated for each fraction:

total;
straight;
indirect bilirubin.

An increase in one or more of the readings may indicate problems with the liver, gallbladder, or the whole body.

How bilirubin is formed

In a healthy person, bilirubin values fluctuate slightly, not exceeding the normal range. The pigment itself is formed inside the spleen and bone marrow during the decay of obsolete red blood cells. Hemoglobin is released from red blood cells, iron is reused, and heme proteins are recycled, giving rise to bilirubin.

Indirect bilirubin or its second name – unconjugated, is transferred by proteins to the liver, where, under the action of a special enzyme – glucuronyl transferase, it binds strongly to glucuronic acid molecules. This is how direct or conjugated bilirubin is formed. This is necessary so that the toxic indirect bilirubin, which is insoluble in water, turns into a soluble and safe direct bilirubin.

The fraction of this pigment associated with blood proteins almost does not enter the blood, being directly excreted into the bile. In the process of digestion, bile bilirubin in the intestinal lumen is broken down under the influence of bacteria, turning into stercobilin. It is brown in color and determines the color of the stool.

Level of bilirubin in the blood

For children and adults, the norms of all fractions of bilirubin determined in blood plasma were calculated.

Bilirubin test: normal in an adult

Direct bilirubin in adults is normal -0 – 5.1 µmol/l.
Adult indirect bilirubin – up to 16.4 µmol/l.
The sum of direct and indirect is total bilirubin. Its norm is 0.5 – 20.5 µmol / l.

Normal in children

Young children have peculiarities in bilirubin levels associated with the work of the liver in processing fetal hemoglobin. They are listed in the table.

Bilirubin: table norm by age

Age of the baby	Total bilirubin
First day	24 – 149 µmol/l
Second or third day	58 – 197 µmol/l
Fourth-sixth day	26 – 205 µmol/l
Older than 6 days	< 21µmol/l

Indirect bilirubin should not exceed 5 µmol/l, the rest is the direct fraction of bilirubin.

When a bilirubin test is ordered

There are a number of indications for which a blood serum test is performed to determine all bilirubin fractions. The following reasons can be distinguished:

Clinical signs of liver tissue damage, problems with the biliary tract. These are dark, frothy urine, jaundice, light-colored stools, itchy skin, soreness, or a feeling of fullness under the right lower ribs.
Examination of newborns in whom physiological jaundice lasts more than 1-2 weeks. In a healthy child, yellowness of the skin increases by 3-4 days and then gradually disappears by 10-14 days.
Suspicion of hemolysis of erythrocytes in congenital or acquired anemia, poisoning. When hemolysis occurs, the destruction of red blood cells inside the vessels with the release of hemoglobin into the blood and its transformation into bilirubin.
Examination of patients who systematically abuse alcoholic beverages. Abuse refers to drinking more than 2 drinks per day (1 drink is 20 g of alcohol per drink).
Liver monitoring in patients taking drugs that have hepatotoxic or hemolytic side effects. Usually, the effect appears as the drug is taken (accumulative effect).
Evaluation of liver status in patients diagnosed with viral hepatitis. It can be type A or B, C, delta and others.
Monitoring a person’s condition if he has serious problems with the organ. These are such diagnoses as cholecystitis, cholelithiasis, hepatitis of various types, fibrosis / cirrhosis of the liver, fatty hepatosis.

In addition, an examination for liver pigments is prescribed as part of a medical examination, for a comprehensive assessment of the state of the body.

Increased level

If for some reason the level of bilirubin in the blood rises, it is not properly neutralized, it is transformed into biliverdin – an oxidized product. Its increase in the blood and tissues provokes yellowness of the skin and mucous membranes. The color can be from lemon yellow, orange to almost olive. This is determined by the ratio of direct and indirect fractions.

Why does the bilirubin level rise? There are several reasons – these are:

reduction in the life span of erythrocytes, which leads to their accelerated decay and the release of excess hemoglobin;
violation of metabolic processes that are necessary for the full metabolism of bilirubin;
decrease in the rate of uptake of bilirubin by liver cells;
inhibition of the process of pigment release into bile;
obstruction of the outflow of bile formed in the liver due to stones, tumors, strictures of the bile ducts.

Most often, the level of bilirubin increases with cholelithiasis, cirrhosis, hepatitis and tumor lesions. Hyperbilirubinemia can be caused by parasites, toxins, anemia, and certain medications.

Depending on the ratio of fractions that are elevated in pathology, it is possible to determine the causes of the pathology. If total bilirubin suffers, these are problems of the liver itself. With an increase in the indirect fraction, the process of destruction of erythrocytes suffers (there is hemolysis). With a high level of direct – the outflow of bile through the bile ducts is difficult.

Symptoms of increased bilirubin

The severity of the pathology is divided on the basis of the clinical picture and the level of bilirubin. An increase to 85 µmol / l with relatively minor manifestations is typical for a mild form of pathology. Moderate severity is set at a level of up to 170 μmol / l, all that is higher is severe pathology, since bilirubin has a toxic effect.

From the side of the liver can be detected:

heaviness, fullness, pain in the right side, under the ribs;
dark urine (color of dark beer) with foam;
change in feces – to light yellow and colorless;
discomfort in the abdomen after eating belching, bloating;
weakness, apathy, dizziness;
fever (with hepatitis).

If the cause of problems is a violation of the outflow of bile from the liver and bladder, yellowness of the skin and sclera, severe skin itching, pain in the right side under the ribs, constipation or diarrhea, severe flatulence, lightening of the feces and dark urine are possible.

In case of problems with erythrocytes and their increased destruction, anemia occurs, stools darken with normal urine color, bruises form on the body against the background of pale skin, itching is possible, which intensifies during sleep and when the skin is heated.

Decreased level

Decreased bilirubin level has no diagnostic value.

Sources:

Influence of the concentration of bilirubin and hydrogen peroxide in the blood on the electrophoretic mobility of erythrocytes. Matyushichev V. B.,
Shamratova V. G. Biological Communications No. 3, 2003. p. 86-90
Standard of care for patients with disorders of porphyrin and bilirubin metabolism. Problems of standardization in health care, 2007. p. 100-106
Indicators of the pigment-forming function of the liver in toxic hepatitis. Lysenko A.S., Osadchiy V.V., Vinogradov A.A. Actual problems of medicine, 2013.

Article published on: 09/06/2016
Last updated : 12/09/2022

norm, causes and consequences of high rates

Bilirubin is a bile pigment, which is considered the main component of bile in the human body. It is formed as a result of the breakdown of proteins into components such as hemoglobin, myoglobin and cytochrome.

Bilirubin in a newborn rises on the 2nd-3rd day of life and increases on the 3rd-4th day – and this is a variant of the norm. This happens for several reasons: due to the increased breakdown of red blood cells, low levels of hemoglobin in the blood, and also due to the poor functioning of the liver.

What is bilirubin

Many parents have heard of neonatal jaundice, which is caused by elevated levels of bilirubin in the blood. Increased showed noted in many newborns, in premature babies – in most cases.

What is bilirubin? It is a bile pigment that is normally formed in the body as a result of the breakdown of red blood cells (blood cells responsible for carrying oxygen). At the same time, in a newborn child, the liver has not yet fully matured; there are not enough enzymes to process decay products. Plus – additional intake of indirect bilirubin from the intestine.

All these conditions in combination affect the fact that newborns often have an increase in the level of bilirubin and develop jaundice. It can be physiological (when bilirubin rises slightly) – such jaundice goes away on its own. But in some cases, pathological jaundice may develop, which requires mandatory treatment. It has been established that it is the degree of maturity of the child, and not his body weight, that determines the level of bilirubinemia. This explains the fact that term infants with prenatal dystrophy rarely experience severe jaundice compared to infants of the same weight but of shorter gestation (1).

What you need to know about bilirubin in newborns

What is the danger of increased bilirubin in a newborn? However, it can be deposited in fatty tissues. There is a risk of bilirubin encephalopathy in the newborn.
Physiological jaundice	This increase in blood bilirubin levels is quite common. Elevated bilirubin occurs in 8 out of 10 newborns. Indicators normalize in a couple of days (2).
Bilirubin level by skin and eye color	Jaundice appears on the whites of the eyes at a concentration of bilirubin from 34 to 51 µmol/l, and on the skin of the face from 68 to 86 µmol/l. When the legs acquire a yellow tint, then the level of bilirubin is too high – about 350 µmol / l.

What tests should be done to check bilirubin

But it is worth remembering that in order to determine the prognosis and choose a treatment method, you never need to focus on a visual assessment of the degree of jaundice (3).

– The most accurate way to determine the level of bilirubin in the blood is a biochemical blood test. It is he who will be prescribed by the doctor if he suspects the development of pathological jaundice, says Anna Levadnaya, pediatrician, candidate of medical sciences, author of the blog about pediatrics . – There is also a percutaneous test – a special device that determines the approximate level of bilirubin in the blood through the skin. Such a test is the fastest, but very approximate, so it is used as an auxiliary one.

In order to distinguish normal physiological jaundice from pathological, in addition to the level of total bilirubin in the blood, the doctor must take into account other factors, so additional tests may be prescribed for the newborn. For example, checking the level of hemoglobin and red blood cells. With physiological jaundice, these values remain normal. The level of direct and indirect bilirubin in the blood is also taken into account. With physiological jaundice, direct bilirubin is less than 20%.

The norm of bilirubin in newborns

— An increase in the level of bilirubin in the blood is observed in almost all newborns in the first 3-4 days of life, says Anna Levadnaya. – In about half of full-term and almost all premature babies, this is accompanied by icteric skin staining. This is noticeable to the eye if the level of bilirubin in the blood is above about 68 µmol/l. With physiological jaundice in full-term babies, total bilirubin is less than 256 µmol/l, in premature babies it is less than 171 µmol/l. If these numbers are higher, and there are also a number of other signs, for example, an earlier onset and prolonged increase in jaundice, dark urine and discolored stools, anemia, then additional examinations are required.

If we talk about the norm of bilirubin in the blood of a full-term newborn, then we should focus on such indicators.

900 81 First day

Child’s age	Blood bilirubin level (µmol/l)
up to 85
36 hours	up to 150
48 hours	up to 180
3-5 days	up to 256
6-7 days	up to 145
in two weeks	up to 20.5

9 0004 Elevated bilirubin in newborns

l with normal health of the newborn and the absence of other alarming symptoms, it is not dangerous. Exceeding this value indicates the development of pathological jaundice – this is already an alarming signal. Conjugational jaundice or conjugative hyperbilirubinemia (increased direct bilirubin) often begins as physiological, but subsequently there is a pathological accumulation of indirect bilirubin in the blood serum (4).

— Do not self-medicate and delay visiting a doctor. Remember, first of all – the health of your child. It is imperative to show the child to a pediatrician, neonatologist, pediatric gastroenterologist, to pass a biochemical blood test. And already, depending on the indicators, the doctor prescribes therapy aimed at the speedy decrease in bilirubin in the blood, – notes Natalia Shorina, pediatrician, neonatologist .

What is dangerous

– Too high an increase in the level of bilirubin in the blood (with pathological jaundice) can lead to brain damage, – explains Anna Levadnaya. – As a rule, this is noted in children with hemolytic disease according to the Rh factor, when there is an increased breakdown of hemoglobin due to an Rh conflict or a conflict in the blood group between the mother and the child, as well as when the level of bilirubin rises above 298-342 µmol/l. In addition, the risk of developing bilirubin encephalopathy is increased by such conditions of the child as prematurity, brain hypoxia, anemia, intrauterine infection, taking certain antibiotics, and others.

– Nuclear jaundice can be suspected when the following symptoms in a newborn: lethargy, drowsiness, poor appetite, vomiting, convulsions, spasm of gaze (deviation of the direction of gaze). The condition can lead to mental retardation, sensorineural hearing loss, gaze paralysis, choreoatotheid cerebral palsy, and death,” adds pediatrician Natalia Shorina. – Elevated bilirubin in the blood of newborns acts as a neurotoxin, damaging brain cells, in severe cases can cause bilirubin encephalopathy. Bilirubin encephalopathy (or its most severe form, kernicterus) occurs due to the fact that bilirubin (at high values of its unconjugated fraction) is able to overcome the blood-brain barrier and be deposited in the child’s brain tissues, damaging them.

How to bring it back to normal

With physiological jaundice, when the level of bilirubin is slightly elevated, the child feels well, no measures to reduce it are needed. The level of bilirubin gradually normalizes, as a rule, this happens by the end of the first month of life.

For a more serious condition, when the newborn’s blood bilirubin level is higher than 256 µmol/l, additional examinations and mandatory treatment are required (1).

In children with hyperbilirubinemia, it is especially important to maintain optimal body temperature, control the intake of a sufficient amount of calories in the body, prevention of hypoglycemia, hypoxemia (lack of oxygen in the blood), acid-base imbalance of the body and thickening of bile is required. There are studies confirming that infants at risk for developing hyperbilirubinemia with early initiation of breastfeeding have significantly lower maximum bilirubin levels than infants who did not receive such nutrition in the first hours of life (5).

— A modern method for reducing bilirubin is phototherapy, says Anna Levadnaya. – Its duration and intensity depend on the child’s body weight at birth, as well as on how much the bilirubin levels are exceeded. In severe cases, the newborn may be given an exchange transfusion. The need for transfusion, its frequency and volume is determined by the doctor. I note that the appointment of sorbents, drugs such as phenobarbital, Essentiale, LIV-52, ultraviolet blood enrichment, electrophoresis or excessive infusion therapy with elevated bilirubin levels are ineffective, and relative to phenobarbital, they are not safe.