About Kernicterus
Kernicterus is a life-threatening and life-altering condition caused by hyperbilirubinemia—an excess of the chemical bilirubin. Bilirubin is usually processed by a properly functioning liver. If the baby’s liver does not process bilirubin, it causes the baby’s skin to turn yellow and take the form of jaundice. Babies with jaundice are at risk for contracting kernicterus.
It is totally preventable when caught quickly and treated properly. Please read the following sections to find out more:
- Jaundice: where kernicterus comes from
- How does jaundice occur? What is hyperbilirubinemia?
- Who is at risk?
- The symptoms and impacts of kernicterus
- Testing and treatment for jaundice to prevent kernicterus
- Where to get information and support
Jaundice: where kernicterus comes from
Kernicterus develops in some newborns as a result of excessive bilirubin—the substance left when red blood cells break down. Bilirubin is normally removed by the liver, however, in kernicterus cases an infant’s body is unable to remove it. Because bilirubin has a pigment, it causes yellowing of the baby’s skin and the whites of the eyes. When this occurs, the baby is diagnosed with jaundice. When caught by a physician quickly and treated appropriately, the child suffers no ill effects as an infant or as he/she matures and grows. In fact, about 60% of all newborns have some level of jaundice.
For most, jaundice goes away naturally in a few days. For others, treatment by phototherapy, where the infant in put under special blue lights for a few hours for a few days cures the condition without impacting the baby at all. In extreme cases where the lights have not worked, and before brain damage can set in or be arrested in its early stages, doctors transfuse the blood of the baby.
Jaundice can become kernicterus if left untreated. You need to consult an attorney because kernicterus is a rare condition which medical experts agree is preventable.
How does jaundice occur? What is hyperbilirubinemia?
It is normal for some red blood cells to die every day. In utero, the mother’s liver removes bilirubin for the baby. Once born, the baby’s liver must take over. Some babies’ livers are not developed enough to efficiently rid the body of bilirubin. This inability to effectively eliminate bilirubin creates a hyperbilirubinemia, the fancy way of describing jaundice, the condition where the baby’s skin yellows. While many babies have some jaundice, the yellow color does not hurt a baby’s skin. It is the bilirubin that is problematic if left unchecked, as it can travel to the brain. (Return to top)
Who is at risk?
Some babies are more likely than others to develop higher bilirubin levels and thus severe jaundice.
Infants with a family history or any of the following risk factors require close monitoring:
- A baby with a brother or sister that had jaundice is more likely to develop jaundice
- A baby who has bruises at birth
- Babies born before 37 weeks (8 ½ months) of pregnancy may have a liver that is not fully developed
- A baby who is not urinating, stooling, or eating well in the first few days of life
- A baby who is yellow in the first 24 hours of life may become dangerously jaundiced
- A baby born to East-Asian or Mediterranean parents
It is also very important to understand that:
- Jaundice is harder to see in babies with darker skin tones
- Some families inherit conditions—such as a deficiency of glucose 6 phosphate dehydrogenate, a chemical found throughout the body, known as G6PD deficiency—and their babies are more likely to develop jaundice
- Women with an O blood type or Rh negative blood factor might have babies with higher bilirubin levels
- A mother with Rh incompatibility should be given Rhogam.
- Depending on the cause of the hyperbilirubinemia, it is critical to know that jaundice may appear at birth or at any time afterward.
In the United States, 60% of full-term infants and 80% of pre-term infants are affected with jaundice. Most cases are not a problem and heal by themselves or can be remedied with highly effective procedures. However, when severe jaundice remains untreated for too long, it can result in brain damage and the condition known as kernicterus. (Return to top)
The symptoms and impacts of kernicterus
The brain damage of kernicterus is caused when the bilirubin levels causing jaundice are so high it travels out of the blood and into the brain tissue. We do not wish to upset the reader, but the consequences of this type of brain damage can cause traumatic instances of:
- Athetoid cerebral palsy
- Problems with vision and/or hearing
- Dental dysplasia
- Mental retardation
Most horrifically, the majority of infants with kernicterus die young.
Symptoms of kernicterus usually appear two to five days after birth in the case of a full-term infant and as late as seven days after birth in the case of a premature birth. However, hyperbilirubinemia may lead to kernicterus at any time during the neonatal period.
Lethargy is a very common symptom of the first stages of kernicterus and must be addressed immediately. Other symptoms include:
- Difficulty to arouse—the baby does not wake up fully or cannot be kept awake
- A high-pitched cry
- Decreased muscle tone (hypertonic) with episodes of increased muscle tone, backwards arching of the head and back
- Fever
If these symptoms continue, the baby may arch their head back into a very contorted position, known as opisthotonus or retrocollis. Contact your doctor. Every moment is precious.
As a baby becomes older, the signs and symptoms of kernicterus change. Babies that are two to three months old show few abnormalities. Later in the first year of life, opisthotonus, muscle rigidity, and seizures are very common. By age three, the complete neurological syndrome is often apparent, including:
- Bilateral choreoathetosis—involuntary movements in a combination with quick movements of the feet or hands and a continuous stream of slow, sinuous, writhing movements, typically of the hands and feet—with involuntary muscle spasms
- Seizures
- Mental deficiency
- Slurred speech
- High-frequency hearing loss
- Squinting and defective upward movement of the eyes
When these symptoms occur, permanent brain damage is occurring and immediate treatment is needed to prevent any further damage. (Return to top)
Testing and treatment for jaundice to prevent kernicterus
Jaundice and its causes in infants are well known. Along with knowing the risk factors and asking your doctors to be mindful at the first signs of any problem, a simple pinprick blood test is very reliable for measuring bilirubin levels.
If you have had your infant tested, or desire to do so, you are looking for TSB test results, or the total serum bilirubin level. A skilled medical professional can easily explain what the measurements mean and if there is cause for concern. If the test confirms the possibility of kernicterus, the treatment focuses on quickly decreasing the amount of unconjugated bilirubin in the blood. Once the amount of unconjugated bilirubin in the blood decreases, the jaundice typically goes away.
According to the University of Virginia Kernicterus & Newborn Treatment, the best known treatment for jaundice is phototherapy. It must start immediately—
- With lights placed as close as possible to the baby
- A stat measurement of blood bilirubin should be sent
- The baby should be hydrated with fluids and tube fed elemental infant formula
- The baby should be blood typed in case a transfusion is needed
If phototherapy does not lower the baby’s bilirubin levels, the baby may need an exchange transfusion. The sooner the bilirubin is decreased, the less permanent brain damage will occur.
Knowledge is power. Messa & Associates cannot emphasize enough that recognizing and treating jaundice can prevent kernicterus. There are no stupid questions and there is no such thing as being overly cautious. (Return to top)
Where to get information and support
Hiring of the best possible legal representation and getting your kernicterus child the medical and financial resources you need is critical. Messa & Associates knows from experience with birth injuries that when one member of a family gets sick, the entire family is touched.
You are not alone. Significant resources are available for you, family, and friends to get informed, and get support from those who have faced this condition and want to help you. (Return to top)
The Centers for Disease Control and Prevention
For a detailed explanation about jaundice, hyperbilirubinemia, and kernicterus, we recommend The Centers for Disease Control and Prevention (CDC) website. Due to the high percentage of infants born with jaundice and the belief that proper treatment can prevent the possibility of brain damage, CDC has classified kernicterus a public health concern. The following links on the CDC site are extremely useful:
Parents of Infants and Children with Kernicterus (PICK)
If your child has kernicterus or if you would like more information, there is a support group called P.I.C.K. (Parents of Infants and Children with Kernicterus). It was formed by families whose children were afflicted with kernicterus, and is rich with information and ways to contact those who know precisely what you are going through. (Return to top)
We never forget that behind every case are real people.
Fighting kernicterus is hard enough. Let Messa & Associates’ Philadelphia birth injury lawyers fight to see that those responsible are held accountable. Our experienced legal professionals and medical experts will evaluate all aspects of your case.
You deserve full compensation for the future care of your loved one, and peace of mind. Call our toll-free number 1-866-401-4LAW (4529), or contact us online today for a free consultation to discuss the details of your case.
