Kernicterus is a rare but dangerous complication of neonatal jaundice in which the baby’s brain is damaged from excessive levels of bilirubin.
Bilirubin is a yellow pigment that everybody has in their blood. It is released into the bloodstream during the body’s normal process of breaking down old red blood cells. It is processed in the liver and stored in the bile duct and gallbladder. Its function is to help the body digest fats in the small intestine, where it is known as bile, and it is then excreted along with the rest of the body’s waste.
What is the difference between kernicterus and jaundice?
When there are excessive amounts of bilirubin in the blood and the liver is unable to process it, the first signs that the baby has excess bilirubin may include:
- yellow discolouration of the baby’s skin
- yellow discolouration of the whites of their eyes
- dark staining of the urine (visible on their nappy)
- pale chalky stools
This condition is known as jaundice and affects 60% of full term babies and 80% of premature babies during the first few days of life. Breast fed babies are at greater risk of neonatal jaundice and may suffer the effects of the condition for as long as a month.
Neonatal jaundice usually lasts up to two weeks and is usually harmless but it must be diagnosed, monitored and treated if it doesn’t resolve early to avoid the development of more serious conditions.
In addition to its own risks, jaundice can be a sign of other conditions which may need treatment, such as:
- Liver disease
- Incompatibility between the mother’s and the baby’s blood groups
- Bruising and metabolic disorders
- Sickle cell anaemia
- Enzyme deficiencies
How does untreated jaundice develop into kernicterus?
When the liver is unable to process the excess bilirubin in the blood, the baby will have hyperbilirubinaemia (too much bilirubin in their blood).
Where a baby has hyperbilirubinaemia (jaundice), their bilirubin levels must be monitored and, if rising rapidly or exceeding the threshold bilirubin levels, the baby must be treated with phototherapy. They will sometimes also need an exchange blood transfusion.
If left untreated, the toxic, unconjugated (not metabolised by the liver) bilirubin can penetrate the blood-brain barrier where it damages the brain and spinal cord, causing neurological dysfunction. This is known as bilirubin encephalopathy and its features - the pattern of damage to the brain – are known as kernicterus.
The baby may show the initial signs of kernicterus brain damage by:
- Poor feeding
- Failing to respond to stimulus, such as clapping hands in front of them
- Decreased muscle tone (floppiness)
- Seizures or fits
- Arching of the spine
Long term disabling effects of kernicterus brain damage vary in severity but include:
- Cerebral palsy
- Hearing loss
- Learning disability
- Impaired eye movements
My baby was brain damaged by delayed treatment for jaundice – how can I find out if I can claim?
At Boyes Turner we are experts in helping children affected by severe brain damage in the birth and neonatal period. If your child has suffered brain damage from kernicterus, our specialists will be happy to advise you about whether your child has a claim arising from negligent care after your baby’s birth, or the treatment they received for jaundice either in hospital or from the community midwives in charge of their care after they were discharged home.
Legal Aid may be available if the child suffered severe neurological injury owing to negligence before or during birth or during the first eight weeks of life.
If you are caring for a child with severe neurological disability which was caused by negligent medical care of jaundice contact the team by email at email@example.com.