What Is Kernicterus and Why It Matters for Your Baby

Kernicterus Explained: Protecting Your Baby from Brain Damage

Kernicterus is a rare but devastating type of brain damage that can occur in a small subset of newborns with severe, untreated jaundice. Jaundice affects approximately 60% of newborns. This happens due to the building up of too much bilirubin in the blood. With some simple treatment, jaundice is managed among babies.

Nonetheless, if there is a high level of bilirubin and the jaundice is left untreated, it develops into a kernicterus condition that damages the brain. Babies with this condition need to be treated immediately.

What are the symptoms of kernicterus?

While mild jaundice is common in newborns and causes a yellowish tint to the skin and eyes, kernicterus is a severe and potentially life-threatening condition resulting from very high levels of bilirubin in the blood.

Its symptoms are more intense and require immediate medical attention. Affected babies may appear extremely sleepy, be difficult to wake, or fall asleep quickly after waking.

Other critical symptoms of kernicterus include:

• Poor or absent reflexes
• High-pitched or constant crying
• Difficulty feeding or lack of appetite
• Limpness or low muscle tone
• Arching of the body (head and heels bent backwards)
• Vomiting
• Fever
• Abnormal eye movements
• Seizures
• Jerky or uncontrolled movements
   

Seek urgent medical help if your baby shows any of these symptoms.

What are the Causes of Kernicterus?

Kernicterus is a rare but serious condition caused by excessively high levels of bilirubin in the blood of a newborn. This occurs when the immature liver is unable to process and eliminate enough bilirubin, allowing it to accumulate and potentially enter brain tissue, leading to neurological damage.

Some key causes of kernicterus include:

• Haemolysis: Excessive breakdown of red blood cells beyond the normal rate, raising bilirubin levels rapidly.
• Polycythaemia: An unusually high concentration of red blood cells in the newborn increases the amount of bilirubin as these cells break down.
• Birth Injury: Trauma during delivery, such as cephalohematoma (blood pooling under the scalp), can contribute to increased bilirubin production.
• Underlying Medical Conditions: Disorders such as Rh haemolytic disease or genetic liver enzyme deficiencies like Crigler-Najjar syndrome impair the ability of the body to process bilirubin efficiently.
   

When bilirubin is not excreted effectively through stool, it accumulates in the blood and may cross into the brain, causing severe and irreversible complications if left untreated.

What are the complications of kernicterus?

Newborns with kernicterus can face the following complications:

• Weak muscle tone
• Spasms in muscles
• Athetoid cerebral palsy is a specific kind of movement disorder caused by brain damage.
• Problems with movement coordination
• Loss of hearing and deafness
• Problems with movement of eyes and looking up
• Intellectual disability
• Stained teeth
• Speaking with difficulty
   

How can kernicterus be treated?

If your baby has a high bilirubin level with certain risk factors, undergoing treatment for kernicterus is essential. Let us explore some key treatment options:

• Phototherapy: This treatment uses special blue lights (in the visible light spectrum, not ultraviolet) shone on the baby's skin. These lights help break down the bilirubin in the skin into a form the baby's body can more easily excrete. The baby wears protective eye coverings to shield their eyes during treatment.
• Intravenous Immunoglobulin (IVIG): If Rh disease prevails in your newborn child, healthcare professionals suggest IVIG. This is an antibody therapy session. Here, fluid or medications are injected directly into a child's blood through a vein in the arm.
   

The goal of phototherapy and IVIG is to rapidly lower bilirubin levels to prevent kernicterus from developing. Exchange transfusion is a critical, high-intensity treatment for dangerously high bilirubin levels when phototherapy is not sufficient. Kernicterus itself (the established brain injury) has no cure, and treatment involves long-term supportive care (e.g., physical therapy, occupational therapy, hearing aids, management of dystonia).

Even though kernicterus is a rare condition, it is essential for parents to stay aware of its complications. By gaining a thorough understanding of the symptoms of kernicterus, risk factors, causes, and treatment, you can safeguard your baby's health with utmost care. Moreover, if you detect any symptoms of kernicterus in newborns, consult medical experts immediately.

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