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Jaundice and Kernicterus

Newborn jaundice is the yellowing of a child’s skin and eyes. Jaundice is not uncommon in newborns and often resolves within a few weeks. However, jaundice and other signs of health conditions should be properly monitored and treated. Failure to care for a child who may be showing signs of jaundice or kernicterus can lead to serious health complications. 

What is Jaundice?

Jaundice in newborns is generally caused by an imbalance of red blood cells. Infant jaundice is a yellowing discoloration of the baby’s skin, mucous membranes, and eyes. The baby’s skin and eyes are discolored because of an excess of bilirubin. In adults, bilirubin is processed by the liver and passes through the body as waste. In a newborn, the liver may not be functioning well enough to remove the extra bilirubin, causing it to build up in the body. 

When the bilirubin levels are out of balance, it can cause problems in the rest of the body. Too much bilirubin can be toxic. Hyperbilirubinemia is a higher-than-normal level of bilirubin. Bilirubin is measured with a blood test, showing the concentration of bilirubin in the blood. This can cause the bilirubin to accumulate in the grey matter of the central nervous system (CNS). 

High bilirubin levels cause temporary or permanent damage, depending on the concentration of bilirubin and how long the levels are elevated before the underlying condition is treated. It can also cause permanent brain or neurological damage. In some cases, untreated hyperbilirubinemia can be fatal.

In most cases of newborn jaundice, the yellowing will clear up within about 2 or 3 weeks. If jaundice continues, it can be a sign of a more serious condition. Liver problems in the newborn can lead to the baby’s inability to process bilirubin. Continued hyperbilirubinemia can increase the risk of deafness, cerebral palsy, and brain damage.

What is Kernicterus?

Kernicterus may develop when severe jaundice goes untreated. Kernicterus is also known as bilirubin encephalopathy and is associated with high levels of bilirubin in the blood. Kernicterus can cause cerebral palsy, hearing loss, and other neurological damage. Kernicterus can also damage vision, teeth, and lead to developmental disabilities. Kernicterus generally does not develop if jaundice is properly treated. 

The signs and symptoms of kernicterus include:

  • Lack of energy or lethargy
  • Poor feeding habits
  • Drowsiness
  • Fever
  • Vomiting
  • Absence of certain reflexes 
  • Muscle spasms
  • Spasticity 
  • Hearing loss
  • Lack of upward gaze

Unfortunately, after a child suffers injury or permanent damage from untreated jaundice or kernicterus, the parents may not know the extent of the damage until much later. The child may not show the characteristics of kernicterus until age 3 or 4, and may exhibit difficulty speaking, mental retardation, or developmental disabilities

Causes of Birth Conditions Jaundice and Kernicterus

Jaundice is common in newborns, especially preterm babies. Preterm babies (born before 38 weeks) may not have their livers fully developed when they are born and their livers have a difficult time processing the bilirubin in the body. This is known as physiologic jaundice and generally peaks between 3 and 7 days after birth. 

Other health conditions can also cause jaundice, including: 

  • Internal bleeding
  • Infection
  • Blood incompatibility (Rh or ABO incompatibility)
  • Cephalohematoma
  • Liver damage
  • Biliary atresia
  • Enzyme deficiency
  • Blood cell abnormality (like sickle cell anemia)

Some babies are at a higher risk of developing jaundice and other bilirubin conditions. Babies with certain skin colors or descent may have an increased risk of developing jaundice, including East Asian babies. Babies with darker skin tones may make it more difficult to detect jaundice so a blood test should be done to show bilirubin levels. 

Babies with significant bruising during birth may also be more likely to get jaundice. Bruising can increase the amount of bilirubin in the body. This can be a concern in difficult labors, which may also lead to other birth injuries. 

Diagnosing Jaundice in Newborns

Diagnosing jaundice generally involves a physical exam and blood tests. Initial signs of jaundice include yellowing of the skin and eyes. A skin test can measure the jaundice level using a transcutaneous bilirubinometer. Blood tests can show the levels of bilirubin in the body and other tests, including urine tests, may indicate if the jaundice has some other underlying cause. 

Early recognition of jaundice and identifying other conditions is important to timely treatment. Treatment to clear up the jaundice, lower the levels of bilirubin, and treating underlying conditions can greatly reduce the risk of damage caused by hyperbilirubinemia or kernicterus. Unfortunately for parents, the doctors or hospitals may make a mistake in diagnosing or treating jaundice, allowing bilirubin levels to get too high or remain for too long, leading to damage. 

Some doctors are very dismissive of the parents’ concerns, which could delay proper treatment of a jaundiced newborn. If you are worried that your doctor is not properly evaluating your child for jaundice, ask about a jaundice bilirubin test that can show the levels of bilirubin in the baby’s blood. 

Jaundice may present a medical emergency if it is accompanied by a fever, the child becomes listless, or the baby is not feeding well. Jaundice may also be an emergency if the jaundice is severe (bright yellow skin), jaundice continues after discharge from the hospital, or the soles of the baby’s feet are also yellow. 

Treatment for Jaundice in Philadelphia

Jaundice often resolves on its own within a few weeks. For more severe levels of jaundice or kernicterus, the child may need to remain in the hospital for extended care. Nutrition is a primary treatment to recover from jaundice, to make sure the baby gets enough nutrients to help proper liver function. Other treatments may include light therapy or use of a fiberoptic blanket. If the baby has very high bilirubin levels, a blood transfusion may be required. 

Philadelphia Birth Injury Attorneys

If a doctor failed to properly care for your child during pregnancy and delivery, talk to an experienced Philadelphia medical malpractice attorney about holding the doctors and healthcare systems accountable for their actions. Our lawyers have successfully represented families in Philadelphia and Pennsylvania to recover damages caused by birth injury negligence. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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