a very rare type of brain damage that occurs in a newborn with severe
jaundice. It happens when a substance in the blood,
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
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
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
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).
diagnoses kernicterus through a physical examination and knowledge of your child's
history of symptoms. Blood tests to measure your baby's bilirubin levels are
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
physiotherapy, speech therapy, and special
The Canadian Paediatric Society (CPS) promotes quality health care
for Canadian children and establishes guidelines for paediatric care. The
organization offers educational materials on a variety of topics, including
information on immunizations, pregnancy, safety issues, and teen health.
Other Works Consulted
Fetus and Newborn Committee, Canadian Paediatric Society (2007, reaffirmed 2011). Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (25 or more weeks' gestation). Paediatrics and Child Health, 12(5): 1B–12B. Also available online: http://www.cps.ca/english/statements/fn/fn07-02.htm.
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.
June 22, 2012
John Pope, MD - Pediatrics
& Chuck Norlin, MD - Pediatrics
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