We have also established a section for medical professionals, including links and other helpful resources in effort to provide accurate information and resources to help prevent and address cases of neurologic disorder caused by newborn jaundice.

OVERVIEW
Most doctors and nurses practicing today have never seen a confirmed case of kernicterus, a permanent but preventable type of brain damage in infants that can lead to cerebral palsy, auditory neuropathy, dental enamel hypoplasia and gaze abnormalities.  A common complication of neonatal jaundice in the 1950s and 1960s, kernicterus was believed to have been eradicated by 1970, at least in the U.S.  Since 1990, however, with the rise in managed care and the early discharge of newborns, kernicterus has re-emerged.

The CDC’s National Center for Birth Defects and Developmental Disabilities (NCBDDD) is aggressively addressing the issue.  In 2001, it issued a Morbidity/Mortality Weekly Report on kernicterus.  Earlier in the year, it announced significant funding over three years for research and prevention of kernicterus.  With PICK and Pennsylvania Hospital, the NCBDDD will launch a national awareness campaign this Fall.

Other health care agencies and organizations are also being aggressive in their efforts to stop kernicterus.  The Joint Commission on the Accreditation of Healthcare Organizations issued a Sentinel Event Alert in 2001, recommending that nurses be empowered to order TSB (total serum bilirubin) or TcB (transcutaneous bilirubin) tests for jaundiced newborns.  The National Quality Forum issued a Never Event in 2001, ranking kernicterus among 27 medical errors that should never happen.

KERNICTERUS: RESEARCH and PREVENTION
This CDC-sponsored report was authored by two of the leading experts on kernicterus:  Vinod K. Bhutani, MD, and Lois H. Johnson, MD, of the BIND Center of Pennsylvania Hospital at the University of Pennsylvania.  The report provides significant data on kernicterus causes and interventions, as well as insight into the re-emergence of kernicterus, most notably, the loss of concern for the neurotoxic potential of bilirubin.

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 jaundice due to a variety of factors including ethnicity, genetic disorders, and perinatal circumstances.  Babies of East Asian and Mediterranean descent have an increased vulnerability to jaundice, as do families with a history of Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency.  Babies that have signs of jaundice in the first 24 hours of life, bruising from delivery, undetected hemolysis or blood incompatibility, infection, and non-optimal sucking may also be at increased risk for severe jaundice.

SIGNS and SYMPTOMS
The warning signs for kernicterus are recognizable and should be treated with urgency.

• Yellow or orange skin tones starting at the head and spreading to the toes
• Lethargy, constantly sleepy
• Weakness, limpness, floppiness
• Difficulty nursing and/or sucking
• High pitched cry
• Arching of the baby's body into a bow, with the head and feet angled toward the back and the torso arching forward

INTERVENTION
There are several steps that you can take.

• Bilirubin measurement within 48 hours of birthing plotted on the nomogram
• Phototherapy
• Exchange transfusion

HOUR SPECIFIC BILIRUBIN NOMOGRAM
The hour specific bilirubin nomogram is designed to help medical professionals assess an infant's risk from jaundice and bilirubin toxicity. To use this nomogram, simply plot the baby's total serum bilirubin (TSB) against age in hours to determine whether the infant is in high-risk or low-risk category. (Click here to go to chart).