60-80% of newborn children in the United States are jaundiced. Jaundice is a condition where the skin is yellow coloring and it affects other tissues. Jaundice can also be identified in the whites of the eyes. Although many newborns may appear jaundiced, they are not deeply jaundiced, meaning that they are not affected below the abdomen. In other words, the newborn will act normally in that they are not too sleepy, they have normal muscle tone, their cry is normal and they don’t arch their backs, all of which are signs and symptoms of the more serious jaundice in newborns.
Kernicterus is a serious form of brain damage that is caused by excessive jaundice in newborns. Jaundice is caused by a substance in the body called bilirubin. When the bilirubin amount is excessively high, it can move through the blood into brain tissue causing brain damage.
Symptoms of excessive jaundice are lethargy, extremely sleepy and difficult to awake on a scale that is abnormal compared to other newborns. In addition, the newborn child may have a high pitch cry and decreased muscle tone. Decreased muscle tone might look like episodes of events like arching of the head and back. As the damage caused by excessive bilirubin increases, the child may arch their head back into a very contorted position. The child may also develop a fever and convulsions or seizures.
In the event that a newborn is diagnosed with excessive jaundice or hyper bilirubinemia, the appropriate treatment will lower the bilirubin level. One of the factors that may cause excessive bilirubin is prematurity, blood group incompatibilities between infant and mother including Rh and ABO blood types and bruising, especially where there is bleeding under the skin of the scalp. All of these conditions can increase bilirubin production and lead to hyper bilirubinemia.
The most common treatment for bilirubin levels is phototherapy, which is treatment with lights. This is the most effective treatment to lower the bilirubin levels. The color of the light is blue which alters the bilirubin from a toxic form to a water soluble, non-toxic form that can be eliminated. However, at dangerous levels of bilirubin or in certain situations where the bilirubin is expected to rise very quickly such as in the case of Rh disease or other hemolytic diseases of the newborn, a more extreme treatment may be used. This would include blood exchange transfusion to rapidly remove toxic bilirubin from the newborn blood supply.
Where there are signs of acute kernicterus in a jaundice baby, brain damage is likely to start. Immediate treatment must be done to prevent more damage or damage that becomes permanent. With the onset of excessive bilirubin the quicker the condition is treated, the greater chance that any brain damage would be reversible.
Where treatment is required immediately, a triple-bank phototherapy lights is put as close as possible to the baby is the recommended course of treatment. Also, an emergency measurement of blood bilirubin should be sent for analysis, but the phototherapy should be started before the bilirubin results are returned from the laboratory. The newborn baby should also be hydrated with fluids and if the baby is not too sick should probably be given an infant formula by way of a tube from the nose or mouth into the stomach. Also, the baby should be blood-typed for possible blood transfusion which should be done as soon as possible unless there is a large drop in the hyper bilirubinemia and the baby improves before the blood is ready for an exchange transfusion.
Too often mistakes are made by a child’s physician when bilirubin is very high. For example, a doctor may not believe the bilirubin level reported from the lab is accurate. That may delay treatment while the bilirubin level of the blood is being retested. Even though the doctor may believe the test was reported inaccurately, there should be no delay in the treatment while waiting for the repeated result. There is no harm to the newborn by treating the child with a huge dose of phototherapy, hydration, ordering a type of cross match and blood for a possible exchange transfusion. In the event that the bilirubin drops quickly and to a safe level, and where there are no symptoms, the exchange transfusion can easily be cancelled.
Delaying treatment or interrupting phototherapy for diagnosing treatment to determine the risk of an exchange is another error and must be avoided by a medical provider. If a sepsis workup or lumbar puncture or echocardiogram or ultrasound study of the heart is needed, it should be done under the phototherapy lights.
Another error in diagnosing and quickly treating excessive bilirubin is not examining the baby for signs of acute kernicterus.
A common error is allowing the bilirubin to reach dangerously high levels. It is very easy for doctors to measure the blood bilirubin. It is much easier to prevent bilirubin from rising too high then to treat it when it does reach excessive levels.
Measuring the bilirubin is important but doctors must not be fooled by a one-day normal reading when the next day the reading is excessive. It is said that a level of 8.5 mg/dL would be in the high-risk zone for a 24-hour old baby. That same reading might be considered a low risk for a child that is 2 days old. The American Academy of Pediatrics guidelines may be useful to determine normal values in bilirubin analysis.
Kernicterus is the name given to the severe form of brain damage caused by excessive jaundice in newborn babies. Kernicterus involves a specific part of the brain. It is the basal ganglia. It may also include lesions damage to the brain stem that affects hearing, eye movement and balance.
Clinically kernicterus may impair specific movements, hearing loss or deafness, impairment of eye movements, especially upward gaze and abnormal staining of the enamel of baby teeth. It is said that children with the unfortunate diagnosis of kernicterus have a form of cerebral palsy. The form of cerebral palsy that is classic for this brain injury is slow, writhing, involuntary movements and abnormal muscle tone. Some children affected by kernicterus are deaf or have some auditory difficulties.
Fortunately, kernicterus is a very rare occurrence. There have been some medical breakthroughs in treating and caring for newborns affected by kernicterus. Most medical facilities have sophisticated screening processes for ruling out excessive bilirubin. However, mistakes are made and children are permanently injured by this condition causing brain damage.
If your child has been injured or damaged by kernicterus, you may be entitled to compensation for medical negligence against the physicians, nurses, hospital and medical providers who were responsible for the treatment of your newborn. Robert Kreisman of Kreisman Law Offices has been handling Chicago and Illinois birth injury cases including those caused by medical providers who have failed to correctly diagnose and treat excessive bilirubin in newborn infants. Kreisman Law Offices has been handling birth injury cases for more than 40 years.
With our years of experience in trying and settling birth injury and birth trauma cases, Kreisman Law Offices provides the best possible services to our clients and have achieved unsurpassed results. Our service is unmatched. Please call us 24 hours a day at 312.346.0045 or toll free 800.583.8002 for a free and immediate consultation, or complete a contact form online. There is no charge for a consultation that will include an evaluation of your case.