Injuries to newborns: Jaundice and a condition called Kernicterus
You’ve probably seen or heard about jaundice – the yellow color in a newborn baby’s skin that typically goes away in the first few days or weeks. What you may not know is that untreated jaundice can sometimes progress to a condition called “hyperbilirubinemia,” which can in turn cause irreversible brain damage, a condition called “kernicterus.” Medical malpractice attorneys at The Veen Firm have significant experience representing children and families whose lives have been tragically changed by the failure of doctors, nurses, and other health-care providers to properly manage jaundice in newborns. We hope that this information will tell you know what you need to know and what you can do – before birth, before leaving the hospital, and after you get home – to help protect your baby from dangerous levels of newborn jaundice.
- What is jaundice?
- What causes jaundice?
- What is kernicterus?
- How is jaundice measured?
- How is jaundice treated?
- What can I do to protect my baby?
- My baby has kernicterus or other harm from excessive jaundice. What should I do?
What is jaundice?
Jaundice is the yellow color in the skin of many newborns. It occurs when a chemical called bilirubin builds up in your baby’s blood. About 60% of newborns have some level of jaundice, and for most, it goes away after a few days and is not a problem.
But some infants are not so fortunate. Bilirubin continues to build up in their blood until it reaches a high level (hyperbilirubinemia). If not treated, hyperbilirubinemia can cause brain damage and a debilitating neurological condition called kernicterus. Early detection and management of jaundice can and should prevent kernicterus.
Jaundice can occur in any baby, regardless of race, ethnicity, or skin color. Jaundice can make your baby’s skin and the whites of the eyes look yellow, but it is not always easy to see jaundice in babies. But most doctors agree that visual assessment alone (just looking at your baby’s skin color) is not a reliable way to measure your baby’s bilirubin level. The best way to tell if your baby has jaundice is with a bilirubin test.
What causes jaundice?
Jaundice occurs when red blood cells break down, and bilirubin is left over. Our bodies break down and create new red blood cells every day, but our livers remove the bilirubin for us. While your baby is in the womb, your liver removes the fetus’s bilirubin through the umbilical cord. But after birth, your baby’s liver must remove the bilirubin on its own. In some newborn babies, the liver might not be developed enough to eliminate the bilirubin until the baby is a few days old. This causes the bilirubin to build up in the blood, and might make the baby’s skin and whites of the eyes look yellow. This yellow coloring is called jaundice. In some cases the jaundice can become so intense that the baby’s skin can appear deep yellow or orange. Bilirubin levels typically peak when your baby is between 3 to 5 days old. Jaundice that appears in the first 24 hours is considered a serious issue, and should always be tested before you leave the hospital.
What is kernicterus?
Kernicterus is a specific type of brain damage that can result when jaundice is not treated properly. When the level of jaundice from bilirubin is not managed properly and becomes too high (hyperbilirubinemia), the bilirubin can become toxic to your baby and may cause brain damage. This condition is called kernicterus. A baby with kernicterus can have cerebral palsy, problems with vision, loss of enamel on the teeth, hearing loss, and brain damage.
Kernicterus was virtually eliminated as a complication in the past, when babies were typically kept in the hospital for three days or more after birth. Now, as babies are routinely discharged from the hospital within 48 hours of birth, kernicterus has reemerged as a rare but devastating result of excessive jaundice. Kernicterus can and should be prevented with proper treatment. No baby should be brain damaged from jaundice.
How is jaundice measured?
The first line of defense against harmful jaundice is to measure the amount of bilirubin in your baby’s blood. The most accurate bilirubin test is a blood test. A few drops of your baby’s blood are taken from a heel prick and tested in the lab. The result is called a total serum bilirubin level or “TSB.”
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One way doctors can measure your baby’s bilirubin level is by holding a device against her skin. This is called a transcutaneous bilirbuin test (TcB).
Another way to test your baby’s bilirubin level is with a device your doctor or nurse holds against your baby’s skin, similar to holding a digital thermometer in your ear to take your temperature. This is called a transcutaneous (“through the skin”) bilirubin level or “TcB.” The skin test is less accurate than the blood test, but is less expensive and easier to perform. The skin test is a painless and inexpensive way to help your doctor determine whether a blood test is required.
The American Academy of Pediatrics created new guidelines in 2004 to help pediatricians and hospitals manage jaundice and prevent kernicterus. The AAP guidelines stopped short of calling for testing every single baby’s bilirubin level, citing concerns about costs and maternal anxiety.
If you have any concerns at all about your baby’s jaundice, demand that your doctor conduct a bilirubin test.
How is jaundice treated?
If your baby gets a bilirubin test, your doctors should treat her jaundice well before her bilirubin gets to a level where brain damage is a concern.
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Conventional phototherapy in the hospital
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Phototherapy can be given at home using a biliblanket
After taking the bilirubin test, your doctor should plot your baby’s bilirubin level on a chart that compares your baby’s bilirubin level to her age in hours. If your baby has a high enough bilirubin level, she may be undressed and put under special blue lights for a treatment called “phototherapy.” The lights will help break down the bilirubin so your baby can eliminate it in her urine. The lights will not hurt your baby.
Conventional phototherapy is done in the hospital, and usually requires admission. In some cases, where the bilirubin is at a safe enough level, phototherapy can be performed at home with a special light blanket called a “biliblanket.” Putting your baby in sunlight is not a safe way to treat jaundice, and could lead to a dangerous sunburn.
In some cases, if the baby has very high bilirubin levels, the doctor may need to do an “exchange transfusion” of the baby’s blood. The baby’s milk intake may also need to be increased. the American Academy of Pediatrics recommends breastfeeding your baby 8-12 times per day to make sure your baby has extra fluids to help eliminate the jaundice.
What can I do to protect my baby?
The following guidelines will give you what you need to know and do – before your baby is born, before you take your baby home from the hospital, and during your first few days at home – to help your baby have a safer experience with jaundice
Before your baby is born – is my baby more likely to have jaundice?
Before your baby is born, you should determine if she has any early risk factors that make her more likely to have jaundice:
- Heredity: A baby born to an East Asian, Middle Eastern, or Mediterranean family is at a higher risk of becoming jaundiced. Also, some families inherit genetic conditions (such as G6PD deficiency), and their babies are more likely to get jaundice.
- Sibling with jaundice: A baby with a brother or sister that had jaundice is more likely to develop jaundice.
- Blood type: Women with an type O blood or an Rh-negative blood factor might have babies with higher bilirubin levels.
Taking action: What can I do?
- Talk to your doctor: If you have any of the above risk factors before your baby is born, talk with your doctor or nurse about jaundice. But remember: any baby can develop jaundice, even those without the above risk factors.
- Ask your baby’s doctor or nurse about a bilirubin test: Whether you have any of these risk factors or not, talk to your doctor or nurse about a bilirubin test. It’s the only reliable way to know whether your baby will need treatment. If you have any concerns at all, insist on having a bilirubin test before leaving the hospital, or at your baby’s first checkup (at 3 to 5 days old).
Before leaving the hospital – is my baby likely to need treatment for jaundice?
Your baby may be more likely to need treatment for jaundice if any of the following risk factors are present before leaving the hospital:
- Preterm babies: Babies born before 37 weeks, or 8½ months, of pregnancy might have jaundice because their liver is not fully developed. The young liver might not be able to get rid of so much bilirubin.
- Feeding difficulties: A baby who is not eating, wetting, or stooling well in the first few days of life is more likely to get jaundice.
- Bruising: A baby with bruises at birth is more likely to get jaundice. The healing of large bruises can cause high levels of bilirubin and jaundice.
- Babies with darker skin color: Jaundice may be missed or not recognized in a baby with darker skin color. Checking the gums and inner lips may detect jaundice. If there is any doubt, a bilirubin test should be done.
Taking action: What can I do?
- Talk with your baby’s doctor or nurse if your baby has any of the above risk factors, or if you have any concerns at all about jaundice. Trust your instincts.
- If you are having trouble breastfeeding, work with your doctor and nurse to get the help you need, or get a lactation consultant.
- Ask your baby’s doctor or nurse about a bilirubin test. It is critical to ask about this test before you take your baby home from the hospital, particularly where any of the above factors are present.
- Make a follow-up appointment. All babies should have a follow-up appointment within 48 hours after they go home from the hospital. Make sure to ask again about your baby’s bilirubin level.
- Ask your doctor to explain results from the bilirubin test and how to track it.
At home: Are there any signs of jaundice that I can see?
Some babies with jaundice might look yellow or even orange, but it is not possible to see jaundice in all babies. This is especially true for babies with darker skin color. There are other signs that your baby may be developing a more serious level of jaundice:
You should talk to your doctor or nurse immediately if your baby has any of the following symptoms:
- Has fewer than 4 wet or dirty diapers in 24 hours (Keep a written record of wet diapers.)
- Is having a hard time feeding
- Is very sleepy and hard to wake, even to feed
- Is very fussy or just can’t be comforted
- Is very yellow or orange (Skin color changes usually start from the head and spread to the toes, but remember: whether jaundice is at a harmful level cannot reliably be determined visually.)
You should get emergency medical help immediately if your baby has any of the following symptoms:
- Is crying inconsolably or with a shrill and high pitch
- Is arched like a bow (the head or neck and heels are bent backward and the body forward)
- Has a stiff, limp, or floppy body
- Has strange eye movements
Even without any of the above symptoms, be sure to go for your follow-up appointment within 48 hours of bringing your baby home from the hospital. If you have any concerns about jaundice and your baby hasn’t had a bilirubin test, ask for a bilirubin test. If you’re worried at all about your baby, trust your instincts. Call or visit a doctor or nurse right away. Finally, if your doctor believes your baby’s bilirubin level test result is too high to be accurate, insist on immediate phototherapy while the retest is being performed.
My baby has kernicterus or other harm from excessive jaundice. What should I do?
The Veen Firm’s attorneys with experience in jaundice and kernicterus cases are here to help. Whether or not we can help you with a potential lawsuit, we will be glad to help direct you to resources available in your area to help get your child the assistance he or she will need. We are happy to provide these services free of charge.
Other Resources:
- If your child has kernicterus or if you would like more information, there is a support group called P.I.C.K. (Parents of Infants and Children with Kernicterus).
- The Centers for Disease Control and Prevention have identified kernicterus as a public health concern. They provide the following resources: