National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Kernicterus


Other Names:
Bilirubin encephalopathy; Hyperbilirubinemic encephalopathy; Kernicterus spectrum disorder
Categories:
Kernicterus refers to brain damage that may occur when neonatal jaundice goes untreated for too long. Physiologic neonatal jaundice (which can affect about 60% of all newborn babies) is a very common condition in which the skin and whites of the eyes are yellowish in color within a few days after birth, due to high levels of a yellow pigment (bilirubin) created when the body gets rid of old red blood cells.[1][2][3] However, in some babies, bilirubin levels may rise excessively (hyperbilirubinemia), which can damage the brain cells.[2] Risk factors for severe jaundice and higher bilirubin levels include premature birth (before 37 weeks); darker skin color; East Asian or Mediterranean descent; feeding difficulties; jaundice in a sibling; bruising at birth; and a mother with an O blood type or Rh negative blood factor.[1][3][4] 

After a few days of jaundice, toxic levels of bilirubin in certain areas of the brain may cause signs and symptoms such as respiratory distress, muscle spasms, and/or low muscle tone (hypotonia). Other symptoms can develop as the baby gets older, such as delayed motor development, seizures, lack of coordination (ataxia), muscle spasms (dystonia), involuntary movements (athetosis), sensory problems, lack of upward gaze, hearing loss, intellectual disability, and difficulty speaking (dysarthria). The term "Bilirubin-induced neurologic dysfunction (BIND)" is used for the signs and symptoms of kernicterus. In most cases, the syndrome develops by 3 to 4 years of age.[1][3][4]

Early detection and management of jaundice can prevent kernicterus. Phototherapy is the most commonly used method to prevent bilirubin toxicity. The definitive method of removing bilirubin from the blood is exchange transfusion.[4] While medications are not usually given to babies with physiologic neonatal jaundice, in some cases,  phenobarbital (an inducer of liver bilirubin metabolism) has been used to reduce bilirubin levels in the blood during the first week of life.[2]
Last updated: 5/30/2018

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Organizations Supporting this Disease

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • You can obtain information on this topic from the Centers for Disease Control and Prevention (CDC). The CDC is recognized as the lead federal agency for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States.
  • MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
  • The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • MeSH® (Medical Subject Headings) is a terminology tool used by the National Library of Medicine. Click on the link to view information on this topic.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Kernicterus. Click on the link to view a sample search on this topic.

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  1. Bilirubin encephalopathy. MedlinePlus. April 2015; https://www.nlm.nih.gov/medlineplus/ency/article/007309.htm.
  2. Hansen TWR. Neonatal Jaundice Medication Updated. Medscape Reference. December 27, 2017; https://emedicine.medscape.com/article/974786-medication.
  3. Facts about Jaundice and Kernicterus. Centers for Disease Control and Prevention. February 2015; http://www.cdc.gov/ncbddd/jaundice/facts.html.
  4. Shelley C Springer, JD, MD, MSc, MBA, FAAP. Kernicterus. Medscape Reference. April 2014; http://emedicine.medscape.com/article/975276-overview.