Kernicterus – a rare complication of neonatal jaundice

By Ruth Nicholson, Solicitor Clinical Negligence

In very rare circumstances, kernicterus (or BIND), a type of brain damage, can occur in new-born babies, sometimes as a result of negligent treatment after birth. In our latest Clinical Negligence blog, Solicitor Ruth Nicholson explains the causes, symptoms and treatment of kernicterus so that new parents can be aware of this rare but dangerous condition.

What is kernicterus?

Kernicterus, or bilirubin-induced neurologic dysfunction (BIND), is a very rare type of brain damage caused by dangerously high levels of bilirubin in the blood.

It is a complication of severe neonatal jaundice and usually occurs within the first week of life in premature babies. Bilirubin is a yellow pigment which circulates in the blood before travelling to the liver, it is then excreted into the bile duct and stored in the gallbladder.

Jaundice (yellowing of the skin and the whites of the eyes) is caused by a build-up of bilirubin in the blood. Mild jaundice tends to resolve within two weeks without treatment. If jaundice gets worse and goes untreated, bilirubin in the blood will build up to a high level.

Throughout pregnancy a mother’s body will remove the extra bilirubin for her unborn baby. Once born it takes a few days for a baby’s liver to become proficient at removing bilirubin. Feeding a baby every 2 to 3 hours during the first couple of weeks can help keep bilirubin moving out of their body through urine and stool.

How does kernicterus occur?

Kernicterus happens when bilirubin levels are extremely high and spread to brain tissue, causing permanent brain damage. Some babies have health problems which increase the likelihood of their bilirubin levels climbing too high, such as a blood disorder called hemolytic disease.

What are the symptoms of kernicterus?

Early symptoms include:

  • Severe jaundice
  • Hypotonia (floppy baby syndrome)
  • Poor feeding

The baby may then develop:

  • High-pitched cry
  • Hypertonia (increased muscle tension)
  • Bulging of the fontanelle (area where skull plates have not yet fused)
  • Seizures

Later features include hearing loss, intellectual disability, muscle rigidity, speech difficulties, seizures and movement disorder. It can also cause stains on the enamel of a child’s primary teeth.

How is it treated?

Phototherapy is a light treatment used to treat jaundice babies. Photo-oxidation adds oxygen to the bilirubin which makes it easier for the baby’s liver to remove bilirubin from their blood.

Where a baby has very high bilirubin levels they can be treated with exchange transfusion. This means that small amounts of the baby’s blood are removed and replaced with blood from a suitable donor.

How is it diagnosed?

Kernicterus can be diagnosed with a physical examination and blood tests. The treatment for any brain damage will depend upon the child’s specific needs. Typical treatment includes speech therapy, physical therapy and specialist support.

It is extremely important to treat jaundice before bilirubin levels get too high. Having an awareness of the symptoms of jaundice can ensure babies are tested and treated promptly.

 

Disclaimer: The contents of this article are for the purposes of general awareness only. They do not purport to constitute legal or professional advice, and the law may have changed since this article was published. Readers should not act on the basis of the information included and should take appropriate professional advice on their own particular circumstances.