Jaundice (Kernicterus)

What's the Problem?

About 60% of newborn babies have jaundice. If not treated quickly and properly, some babies with jaundice can suffer brain damage and a life-long condition called kernicterus. Some of the problems caused by kernicterus are athetoid cerebral palsy, hearing loss and sometimes mental retardation. It can also cause problems with a baby's vision and teeth.

In some newborn babies, the liver makes too much yellow pigment called bilirubin. When too much bilirubin builds up in a new baby's body, the skin and whites of the eyes turn yellow. This yellow coloring is called jaundice. Jaundice is very common in newborn babies and usually goes away by itself. A little jaundice is not a problem, but a few babies have too much jaundice. If not treated, high levels of bilirubin can cause brain damage, known as kernicterus.

Who's at Risk?

Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves.

Some babies are more at risk to develop jaundice than others:

• A baby with a brother or sister that had jaundice
• A baby with bruises at birth
• A baby who is born preterm
• A baby who does not feed, urinate, or stool well
• A baby who is yellow in the first 24 hours of life
• A baby born to parents who have dark skin tones
• A baby born to an East Asian family
• A baby born to a Mediterranean family

Can It Be Prevented?

Yes. Jaundice is easily and effectively treated with phototherapy. That is, the baby can be put under special lights for most of the day. The lights do not bother the baby. If the baby gets extremely jaundiced, the doctor can do an exchange (special blood) transfusion.

The Bottom Line

Kernicterus is an easily preventable life-long disability. It is easy to treat if managed properly, but left untreated it can cause a serious problem to an otherwise healthy baby.

Unfortunately, many infants are not routinely tested for bilirubin levels, which would indicate the severity of jaundice, before they leave the hospital, or when jaundice is identified. The test is easy to perform and inexpensive. A blood sample to test bilirubin could easily be done at the same time a baby is pricked for newborn metabolic screening.

Administering this test could help to prevent this tragic disability. This test is particularly important because jaundice can sometimes be missed in babies with dark skin tones.

Case Example

Cal, a 7-pound healthy baby boy, is born at a large, accredited hospital. Less than 24 hours after birth, Cal's skin looks yellow but he is still sent home on time, even though he has extreme jaundice. Like at most hospitals, the doctors perform several tests, but not a quick and simple blood test to measure his bilirubin levels, which would show the severity of his jaundice.

A few days later, Cal is lethargic and isn't feeding well. Cal's mom takes him to the doctor, who tells her to wait and see if he will improve. Twenty-four hours later, Cal is taken to the hospital. Although his bilirubin levels are dangerously high, the doctors do not perform a special blood transfusion. Instead, Cal receives light therapy, which is not enough. The next day, Cal has difficulty breathing and he starts to arch his neck – symptoms of brain damage taking place. It is too late.

Cal's severe jaundice leads to a condition called kernicterus. He cannot walk without help, has difficulty speaking, drools and has uncontrollable movements of his arms and legs. Cal's kernicterus was totally preventable.