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Kernicterus is a very rare type of brain damage that occurs in a newborn with severe jaundice. It happens when a substance in the blood, called bilirubin, builds up to very high levels and spreads into the brain tissues. This causes permanent brain damage.
Kernicterus may be prevented by treating jaundice early before it gets severe.
Kernicterus is caused by a high level of bilirubin in a baby's blood. If left untreated, the bilirubin can then spread into the brain, where it causes long-term damage.
A low-level buildup of bilirubin is normal. This is called mild jaundice, and it gives a newborn a slightly yellowish tint to the skin and sometimes the eyes.
Normally, extra bilirubin is removed from the bloodstream by the liver and kidneys, and it leaves the body in urine and stool. During pregnancy, the mother's body removes the extra bilirubin for the baby. After birth, it takes a few days for the newborn's liver to get good at removing bilirubin from the blood. If you feed your baby every 2 to 3 hours, mild jaundice will usually go away on its own after a few days. But if your baby has any signs of jaundice, you and your doctor will need to watch him or her closely.
If jaundice continues to get worse and is not treated, bilirubin in the blood can build up to a high level. This is when kernicterus becomes a concern. It may be that some babies have health problems that make them more likely to have bilirubin levels that climb to high levels. For example, hemolytic disease, in which a mother's Rh blood factor is not compatible with her baby's, can make a baby produce more bilirubin than normal. Intestinal blockages can make it harder for a baby to remove bilirubin.
Kernicterus has likely already started if a baby has certain symptoms, including:
The lifelong damage from kernicterus may cause long-term:
Kernicterus may cause stains on the outside (enamel) of a child's baby teeth (primary teeth).
Your doctor diagnoses kernicterus through a physical exam and knowledge of your child's history of symptoms. Blood tests to measure your baby's bilirubin levels are also done.
Once a baby has kernicterus, brain damage has already occurred. For this reason, it is important to follow and treat jaundice before bilirubin levels get too high.
You may be able to help prevent kernicterus by being aware of the symptoms of jaundice and making sure your baby gets testing and treatment when needed.
Quick treatment may help prevent further brain damage. Treatment may start with light therapy and fluids given through a needle into a vein (intravenous fluid replacement). Sometimes a baby may also have a tube placed down his or her throat or into the stomach for feeding with a special type of formula. A baby will also have a blood type test so that he or she can quickly get a blood transfusion if it is needed. A blood transfusion may be given to help remove extra bilirubin from the baby's blood.
Long-term treatment for brain damage will depend on a child's specific problems. Typical treatment includes physical therapy, speech therapy, and special education.
Other Works Consulted
Maheshwari A, Carlo WA (2011). Digestive system disorders. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 600–612. Philadelphia: Saunders.
Watchko JF (2012). Neonatal indirect hyperbilirubinemia and kernicterus. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 1123–1142. Philadelphia: Elsevier Saunders.
Current as of: May 27, 2020
Author: Healthwise StaffMedical Review: John Pope, MD, MPH - PediatricsKathleen Romito, MD - Family MedicineChuck Norlin, MD - Pediatrics
Current as of: May 27, 2020
John Pope, MD, MPH - Pediatrics & Kathleen Romito, MD - Family Medicine & Chuck Norlin, MD - Pediatrics
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