🎯 Learning Objectives

By the end of this lesson, learners should be able to:
✅ Explain what bilirubin is and how it builds up in newborns
✅ Describe the types of bilirubin testing (skin vs blood)
✅ Understand why early testing is critical in Africa
✅ Identify where and how to access reliable testing services

🧪 What is Bilirubin?

Bilirubin is a yellow substance made when red blood cells break down. Babies are born with more red blood cells, and their liver is immature, so bilirubin builds up more easily in their blood and skin — causing jaundice (yellowing).

If too much bilirubin stays too long, it can enter the brain and cause kernicterus, a dangerous and permanent form of brain damage.

🔬 Why Bilirubin Testing is Important

Visual signs alone are not enough — especially on dark-skinned babies where yellowing may be missed until it’s severe. Testing gives an accurate bilirubin level, which helps doctors:

• Know if jaundice is normal or dangerous

• Decide whether to admit the baby for treatment

• Track progress during home or hospital care

📌 In African settings where jaundice is often caught late, early bilirubin testing can literally save lives.

🧫 Types of Bilirubin Tests

1. Transcutaneous Bilirubin Test (TcB)

• Non-invasive: A device is placed on the baby’s skin (usually forehead or chest)

• Gives instant results

• Often used in hospitals or well-equipped clinics

📷 Example: Dräger JM-105 or Bilicare Device

2. Blood Test (Serum Bilirubin Test – SBR)

• Requires a small blood sample, usually from the heel or vein

• More accurate, especially in very sick or preterm babies

• Measures total and direct bilirubin levels

⚖️ Which is better?

• TcB is good for screening

• Blood test is used to confirm and monitor treatment decisions

🩺 When Should a Baby Be Tested?

🔴 If baby is premature, low birth weight, or has a sibling who had jaundice, testing is especially urgent.

📍 Where to Access Bilirubin Testing in Africa

• Referral Hospitals & Teaching Hospitals (e.g., Kenyatta National Hospital, Korle-Bu, UCH Ibadan)

• Selected Private Clinics (with neonatal units)

• Outreach Labs (some offer mobile heel-prick bilirubin testing)

• CHW-supported testing programs (with handheld TcB devices – pilot programs in Uganda, Kenya, Nigeria)

📞 Contact local health facility or CHW to ask if bilirubin testing is available. If not, refer to a larger center quickly.

📚 Further Resources

• WHO Guidelines on Jaundice: https://www.who.int/publications/i/item/9789240049072

• AAP Hyperbilirubinemia Toolkit: https://pediatrics.aappublications.org/content/early/2022/06/13/peds.2022-057882

• Clinical Trials on TcB Accuracy: https://clinicaltrials.gov/ct2/show/NCT04606511

🧠 Real-World Case

“A CHW in rural Nigeria used a color scale and spotted early jaundice in Day 2. The baby was referred to the district hospital. Blood bilirubin was high. With phototherapy, the baby fully recovered. Without testing, the child could have developed brain injury.”

📝 Quiz – Bilirubin Testing

Q1. Why is bilirubin testing important in dark-skinned babies?
A. Because dark skin absorbs bilirubin
B. Because yellowing may not be visible
C. Because light skin doesn’t get jaundice
D. Because of breastfeeding

✅ Answer: B
Rationale: Jaundice can be missed by eye on darker skin tones, making testing essential.

Q2. Which bilirubin test is non-invasive?
A. Heel-prick blood test
B. Transcutaneous bilirubin (TcB)
C. Urine test
D. X-ray

✅ Answer: B
Rationale: TcB tests bilirubin using light sensors on the skin—no blood needed.

Q3. What should you do if bilirubin is still high after Day 7?
A. Wait another week
B. Give sugar water
C. Refer for urgent hospital evaluation
D. Rub with charcoal

✅ Answer: C
Rationale: Persistent jaundice beyond 7 days needs urgent medical evaluation.