- Jaundice in newborns, caused by high bilirubin levels, can lead to a condition called kernicterus which involves bilirubin crossing the blood-brain barrier and damaging brain tissue. - Kernicterus is diagnosed through signs like extreme passivity in infants and treated through phototherapy which uses specific wavelengths of light to break down bilirubin levels. - While jaundice is common in newborns, levels should decrease within a few days and medical care may be needed if it persists or worsens to prevent permanent brain damage from kernicterus.

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Kernicterus, the Preventable Newborn
Disease You Never Heard Of
Guest Post | August 21st, 2013 | Posted in Birth Injury New s
What Is the
Bilirubin Count in
Newborns?
Sometime after your
beautiful baby is
born, he or she will
be checked for the
bilirubin count. Fifty
years ago, the test
was commonly administered within several hours of birth, and
again if the level was too high and your newborn showed signs
of jaundice.
Jaundice in newborns can still lead to seizures and brain
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Kernicterus, the Preventable Newborn Disease You Never Heard Of
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Jaundice in newborns can still lead to seizures and brain
damage, but the ways of checking for it, and treating it, have
changed – largely for the better. What used to be a painful (if
you are newborn) heel prick and a TSB (total serum bilirubin)
blood test is now, in many cases a universal screening, with
babies undergoing a (painless) transcutaneous bilirubin (TcB)
skin test. Some infants may get both, or one of the above and a
test of the cord blood as well.
The point of the skin test is that results can be obtained almost
immediately, where some TSB tests remain tied up in the
hospital laboratory, waiting on a technician, sometimes after the
parents have taken their newborn home. In addition, skin tests,
which help reduce discomfort in newborns and a reduction in
hospital costs, may pinpoint trouble even among populations
where such tests are skewed as a result of racial or ethnic
pigmentation.
Finally, pediatricians may administer the Bhutani nomogram to
determine just how much bilirubin is present in an infant’s
circulatory system.
Hyperbilirubinemia, or excessive levels of bilirubin, which
manifest as a jaundiced or yellowed appearance of the skin of
the face and upper torso – and the whites of the eyes – and a
serum bilirubin level (via the above-mentioned tests) of greater
than 15 milligrams per deciliter (mg/dL), can – if prolonged, be
very dangerous.
What is Kernicterus?
Bilirubin is a pigment manufactured in the body during the
recycling of old red blood cells. Adults rarely display jaundice,
the telltale sign of high bilirubin, but infants, who cannot recycle
old blood cells as fast as adults, do. Nor are their newly
functioning organs – in this case, the liver, as efficient as they
will be after a couple of days of practice. As a result, neonatals
(another name for newborns) can experience a buildup of
those cells, particularly in the traumatic hours after birth, as the
infant’s system adjusts to living outside the womb.
Normally, the red blood-cell recycling process, called
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hemolysis, functions well enough to clear an infant’s blood
stream within the first 24 hours after birth. But because not all
babies are born equal, many neonatals don’t clear bilirubin as
effectively as they should, and these break-down levels of
bilirubin can build up to levels so high they move out of the
bloodstream and into the brain, crossing that almost mythic
blood/brain barrier where they may damage the basal ganglia –
or that part of it called the globus pallidus.
What Are the Warning Signs of Kernicterus?
If your baby is in danger, he or she will exhibit warning signs.
One is extreme passivity; these babies are hard to wake, hard
to keep awake, and show no signs of being aware of their
surroundings (jerking, writhing or crying at being too cold or
hot, or hungry, or wet, or needing to be held).
These infants may also have a thin, shrill cry, and may feel, to
parents and nurses, like they have no control over their bodies;
many are described as behaving like “rag dolls”. This lack of
control may also cause their torsos to bow upward when lying
on their backs – one of the dread signs of terminal meningitis.

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One final sign, called dental enamel hypoplasia, or white
spotting on the teeth, will not be evident for at least another six
months.
Kernicterus and Your Pediatrician
Even today, with all the diagnostic and treatment modalities
available to care for newborns, pediatricians are about equally
divided on the value of these measures, with some seeing no
advantage and others seeing them as essential. What this
means to new parents is that some pediatricians may cause,
rather than correct, childhood injuries. Infants getting TcB not
only get light therapy, or phototherapy – the newest form of
treatment – but may get it even when their bilirubin levels are
close to normal.
In enough instances to be disconcerting to parents, some
infants may often receive more phototherapy than needed, or
be misdiagnosed merely by appearance if they are ethnic; i.e.,
Asian American, Hispanic or African American (not to mention
some minor ethnic divisions like Native American, Hawaiian
Islander, or immigrants from Middle East nations like Egypt,
Iran, and Jordan, or even Armenians – a now almost-extinct
group considered Indo European). Fortunately, there is no
overdosing with phototherapy, as there might be with some
other treatments.
When to Worry
Sixty percent of newborn babies in the United States are
jaundiced, so the mere appearance of yellowed skin, or the
whites of the eyes, is no reason to be alarmed. However, if the
condition persists for more than a few days and seems to be
getting worse rather than better, you might want to call in a
specialist or insist your infant be transferred to a pediatric
specialty hospital, which has all the bells and whistles for
managing incipient Kernicterus.
How to Treat Kernicterus
Also known as chronic bilirubin encephalopathy, Kernicterus
responds well, and sometimes very rapidly, to phototherapy, or

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colored-light therapy. First discovered by a nun who believed in
giving her charges air and sunlight to improve their health, the
treatment has since morphed into a specific frequency of blue
light (not ultraviolet, or UV, light, as is sometimes thought).
This light can come from overhead lamps, or from an odd
looking item called a Biliblanket, which is put on under the
baby’s clothing, next to its skin, insuring that the full dose is
received rather than disbursed in a circle around the infant.
In addition to phototherapy, or in situations where the
newborn’s health is rapidly failing, an aggressive program of
exchange transfusions quickly rid the blood of bilirubin
buildups. Because this is such an aggressive approach,
reputable pediatricians prefer to try it only after all other
treatments have failed to produce desired results, or if the
infant has a total serum bilirubin of greater than 25 mg/dL.
Additional feeding may also help speed bilirubin through the
newborn’s metabolic system, where it can be disposed of
through fecal matter. This bilirubin excretion is, as a matter of
fact, one of the primary reasons why newborn and infant stools
are yellow rather than brown.
For those dealing with a newborn in whom Kernicterus may not
have been caught and treated in time, an excellent source of
information, and comfort, can be found at PICK, Parents of
Infants and Children with Kernicterus.
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