For Professionals

Overview
Kernicterus is a preventable type of brain damage caused by excessive bilirubin (hyperbiliruninemial) in the neonatal period. Athetoid cerebral palsy, auditory neuropathy, dental enamel hypoplasia and gaze abnormalities are common neurological sequlae. In 2001 The National Quality Forum issued a ‘Never Event’, ranking kernicterus among 27 medical errors that should never happen.
Risk Factors
All babies produce bilirubin and are at some risk for bilirubin toxicity if not well monitored and managed. Some babies are more susceptible to developing problematic, severe jaundice. Those with any of the following risk factors should be closely monitored for rising bilirubin:
  • Mild prematurity (around 37 weeks gestation)
  • Bruising/hematomas on the face and head during delivery
  • Vacuum delivery
  • Jaundice developed in the first 24 hours of birth
  • Babies with a different blood type than the mother (also called ABO incompatibility)
  • Babies with Rh factor incompatibility (Rh negative mother with Rh positive baby)
  • Babies who have a sibling who was jaundiced
  • Babies that lose a lot of weight after birth (how much?)
  • Large birthweight babies (per mayo clinic – FACT CHECK)
  • Babies who aren’t nursing well
  • Babies of East Asian and Mediterranean descent
  • Babies with Glucose-6-Phosphate Dehydrogenase deficiency (G6PD)
  • Babies with certain genetic and/or congenital disorders (i.e. hypothyroidism)
Signs and symptoms of bilirubin toxicity
When infants have signs of brain dysfunction from bilirubin toxicity, immediate medical treatment is needed to minimize permanent brain damage. Each passing minute of excessive newborn jaundice raises the risk of severe lifelong neurological damage.The signs of acute bilirubin toxicity when in combination with jaundice include:
  • abnormalities of tone, including increased tone (hypertonia), decreased tone (hypotonia), or a variation in tone from hypertonia to hypotonia,
  • lethargy, difficulty in arousing the baby,
  • a high-pitched cry,
  • arching the back and spine (retrocollis or opisthotonus), and
  • fever
Intervention
Some physicians have asked if signs of acute kernicterus are present is it too late to treat. The answer is NO! Although damage may have occurred, when the infant is jaundiced and signs are occurring, damage is continuing to occur. The sooner the bilirubin is reduced, the better, the less permanent brain damage will occur. THIS IS A TRUE MEDICAL EMERGENCY! Delay will make the damage worse.
With an excessively high bilirubin level and with signs of acute kernicterus, arrangements should immediately be made for a double volume exchange transfusion. This may take a few hours, even in the best of medical centers. In the meantime, the baby should be given double or triple phototherapy with the lights as close as possible to the baby with maximal surface area exposed (and the eyes covered), and the baby should be fed orally or by gavage tube with Nutramigen or another elemental formula, to eliminate bilirubin via the gut. Dehydration may be corrected by intravenous infusion, but gastrointestinal feeding should not be ignored unless the baby is having a seizure or severely ill.
*be certain to use total serum bilirubin levels, NOT unconjugated bilirubin levels, for making treatment decisions
Sources
Some of the above information is excerpted from information from www.kernicterus.org, a site for parents and professionals about kernicterus and newborn jaundice developed by Dr Steven Shapiro, MD, Children’s Mercy Hospital, Kansas City, Missouri
Additional information for medical professionals can be found at the Center for Disease Control website
show
 
close