Bilirubin occurs naturally in the human body. However, like many other body chemicals, when the balance of chemicals is not controlled, too much bilirubin can be toxic. When a child is born with too high of a concentration of bilirubin, it can cause brain damage. In serious cases, high bilirubin levels can be fatal.
In newborns, slightly elevated levels of serum bilirubin are not uncommon. However, it is important for doctors to be aware of bilirubin levels, monitor concerning lab results, and act to reduce the risk of bilirubin-induced neurologic dysfunction. Failure to properly monitor and care for the mother and baby that results in injury could lead to a claim for medical malpractice.
What is Bilirubin-Induced Neurologic Dysfunction?
Bilirubin-induced neurologic dysfunction (BIND) involves neurologic injury or brain injury caused by elevated levels of serum bilirubin in the blood. Hyperbilirubinemia can cause the substance to accumulate in the grey matter of the central nervous system (CNS), causing permanent damage. The extent of damage can range from minor to severe, and in some cases, may be fatal.
Hyperbilirubinemia can occur in adults but can be most dangerous for newborns. In an adult, bilirubin increases can lead to jaundice, usually related to a problem in the liver. In newborns, their brains and nervous systems are still developing and can be easily damaged when there is an imbalance in blood chemistry. The blood-brain barrier is not as developed as in adults and a baby’s liver is also still developing and vulnerable to overloads.
Kernicterus Neurological Disorder
Kernicterus is another term for bilirubin encephalopathy. Bilirubin encephalopathy and kernicterus are different terms involving a similar condition, which is damage caused by hyperbilirubinemia. BIND is the damage caused by neonatal hyperbilirubinemia. The different terms and names for medical conditions, causes of conditions, symptoms, and injuries can be confusing for parents who are trying to understand what is happening to their newborn.
Causes of BIND
There are a number of risk factors that may increase the chance of a newborn developing bilirubin-induced neurologic dysfunction, including a low gestational age, low birth weight, hemolysis, sepsis, cephalohematoma or easy bruising, and exclusive breastfeeding. Even though it is generally preventable in modern hospitals, it continues to be a problem for patients because of delays in receiving treatment.
Signs, Symptoms, and Treatment for BIND
Although neonatal jaundice is common in newborns, bilirubin encephalopathy is much less common. Signs and symptoms of bilirubin encephalopathy can be classified by the extent and of bilirubin disruption, as:
- Acute bilirubin encephalopathy (ABE)
- Chronic bilirubin encephalopathy (CBE)
- Subtle bilirubin encephalopathy (SBE)
Acute Bilirubin Encephalopathy (ABE)
Acute bilirubin encephalopathy is the acute illness caused by severe hyperbilirubinemia. Signs of acute bilirubin encephalopathy can include:
- Decreased feeding
- Abnormal tone
- High-pitched crying
- Retrocollis or opisthotonos (spasms or repetitive muscle contractions in the neck)
- Setting-sun sign (eyes appear driven downward)
Treatment involves reducing the bilirubin levels in the body immediately. However, a number of these signs can continue for 2 to 3 weeks after acute bilirubin encephalopathy.
Chronic Bilirubin Encephalopathy (CBE)
Chronic bilirubin encephalopathy is a chronic state of bilirubin-induced lesions on the brain and brain stem and reducing bilirubin will not immediately reverse the damage to the neurological system. Signs of CBE can include:
- Abnormal motor control
- Abnormal movements and muscle tone
- Auditory processing disturbance with or without hearing loss
- Eye movement impairments (including setting-sun sign)
- Tooth enamel dysplasia
- Impaired digestive function
Chronic bilirubin encephalopathy can cause serious neurological damage, including cerebral palsy. Cerebral palsy causes those affected to have “impaired movement associated with abnormal reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking or some combination of these.”
Dyskinetic CP, associated with CBE, involves uncontrollable movements of the hands, arms, feet, and legs. Individuals may be unable to walk or find it difficult to sit down. The uncontrolled movement may also affect the head and face, making it difficult to eat, swallow, or talk.
Subtle Bilirubin Encephalopathy (SBE)
Subtle bilirubin encephalopathy is a chronic state of mild bilirubin-induced neurological dysfunction (BIND). SBE is also referred to as subtle kernicterus. This involves the presence of subtle developmental disabilities without a classical finding of kernicterus.
Outcomes for Children with BIND
Outcomes for children with BIND vary depending on the extent of bilirubin disruption. BIND conditions may include:
- Auditory imperception or Aphasia – Loss of the ability to communicate, understand, or express speech
- Central auditory processing disorders – difficulty understanding speech in noisy environments, following directions, or distinguishing between similar sounds
- Sensory and sensorimotor integration disorders – improper responses to sensory information, including appearing uncoordinated, clumsy, be unable to tell where their limbs are in space, or find it hard to engage in play or conversation
- Hypotonia – decreased muscle tone
- Ataxia – degenerative nervous system disease that may make people appear drunk or clumsy
It may take time before parents understand the extent of the injury to their child and only appear to be a problem when the child begins to show developmental delays. BIND may manifest as cognitive impairment, language development, disordered brain function, or behavioral disorders.
Is BIND Caused by Medical Negligence?
Neonatal hyperbilirubinemia is caused by high levels of bilirubin in the blood. However, there are a number of risk factors that increase the chances that a child will have high bilirubin levels. When a doctor is caring for a patient, they should be aware of the risks of jaundice and bilirubin encephalopathy, especially when the mother or baby may have related risk factors.
After the baby is born, blood tests and diagnostic tests can look at the chemical levels in the blood, including bilirubin levels. When these levels are out of normal proportion or abnormally high, the levels need to be monitored or be treated before any further damage can occur.
Medical malpractice is the failure of a doctor to provide the proper standard of care that causes injury to a patient. If the doctor is negligent in failing to properly monitor a patient, or there is delayed treatment of a serious condition, it can cause injury to the patient, including BIND or bilirubin encephalopathy.
Birth Injury and Brain Injury Attorneys
If a medical mistake involving liver function or blood monitoring caused a birth injury to your child, talk to an experienced medical malpractice attorney about holding the doctors and healthcare systems accountable for their carelessness. Do not hesitate to contact Gilman & Bedigian today for a free consultation.