Kernicterus and Untreated Jaundice in Newborns

Kernicterus is a rare form of birth injury which results from a newborn’s inability to process excess levels of bilirubin in the blood after birth. Babies are typically born with a surplus of red blood cells, and their bodies accumulate bilirubin as it breaks these cells down. A newborn’s liver often becomes overworked in processing this compound, and many babies will develop jaundice as a result. In serious cases, bilirubin can cause a yellowing of the eyes and skin and, if left unchecked, it can migrate to the brain and cause permanent and severe damage.

In most cases, newborn jaundice will go away on its own within a few days or so as the baby’s liver continues to strengthen and the baby begins nursing or drinking formula, which helps the bilirubin pass through the body. Jaundice is typically nothing to be concerned about, as approximately 60% of babies born in the United States have a small amount of jaundice in the days following birth. However, kernicterus is an extremely severe form of jaundice that occurs when bilirubin migrates to the brain. This condition can cause birth injuries. Kernicterus, also known as a “never event,” is a serious and harmful event that should never occur because it’s largely preventable.

How kernicterus occurs

Too much bilirubin in the blood is called hyperbilirubinemia, a condition which leads to jaundice. During the course of pregnancy, the mother’s liver does the work removing excess bilirubin for the baby. If a baby’s liver is slightly undeveloped at birth and it’s still unable to remove all the excess bilirubin from its blood, it may develop a case of jaundice.

Doctors should test newborns for jaundice at birth, around three days, and then again at about a week. Minor cases of jaundice typically clear up on their own or with minimal treatment, usually with light therapy. However, if jaundice becomes severe and goes untreated or improperly treated, it can lead to the serious condition kernitcterus.

Dangers of kernicterus

Kernicterus can have devastating consequences to a newborn. If excess bilirubin is allowed to pass into their brain, it causes a condition called acute bilirubin encephalopathy. If left untreated, this can lead to permanent brain damage. The bilirubin is toxic and can permanently stain the brain’s gray matter. Kernicterus can cause hearing loss, cerebral palsy, a permanent upward gaze, underdeveloped tooth enamel, learning disabilities, and, in worst-case scenarios, death.

What are the risk factors for jaundice?

Obstetricians, doctors, and midwives should always be on the lookout and prepared for risk factors that can cause jaundice:

• Premature birth
• East Asian or Mediterranean descent
• Difficulties feeding
• A sibling with jaundice
• Bruising (healing bruises causes excess bilirubin)
• Infections, like syphilis, rubella, or sepsis
• Blood type mismatch between the mother and baby (Rh incompatibility)
• Macrosomia (abnormally large baby)

Jaundice is not an uncommon condition in newborns, and in most conditions is easily treatable. Unfortunately, if jaundice is allowed to develop into the life-threatening condition kernicterus, your child may have been a victim of medical malpractice.

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