All parents need the facts about this birth injury. While it seems there is a whole medical vocabulary to learn, our attorneys answer parents’ most pressing questions in the FAQs section below. Understand the signs and symptoms of kernicterus, the treatments, and become proactive in protecting your child’s future.
Excessive Newborn Jaundice – A Preventable Birth Injury
After delivery of a healthy baby, new parents return home with their newborn. Over the following days, their baby doesn’t seem quite right. He is hard to wake, his skin and eyes have a yellowish tint, and he has trouble nursing. They take the infant to their pediatrician for a check up, and learn that their baby has severe jaundice. They also learn that it’s too late to treat him – and that their child has suffered irreparable brain damage because of something called “kernicterus.”
A form of brain damage that can attack babies who have newborn jaundice, kernicterus occurs when a substance in the baby’s blood − bilirubin − builds to toxic levels and leaks into the brain tissue.
This event is especially tragic because it is preventable. Is medical negligence to blame? Too often, the answer is yes.
Most newborns have mild jaundice to some degree. The signs of jaundice are well known and treatment is standard procedure. The trouble begins when high bilirubin levels are not immediately monitored and treated.
When levels of bilirubin become excessive and the jaundice becomes severe, a baby can suffer devastating damage to his or her brain and neurological system. Severe cases can end in the child’s death. Babies that survive suffer from a range of disorders including forms of cerebral palsy, hearing and vision loss, developmental impairments and mental retardation.
Ratzan Weissman & Boldt stands ready and able to represent victims of this crippling birth injury throughout Florida and across the United States. In our 20-year history as medical malpractice attorneys, these cases stand out to us because they should never occur.
Kernicterus Information for Parents
Kernicterus, also known as Chronic Bilirubin Encephalopathy, is a rare but severe complication from abnormally high levels of bilirubin in the blood (hyperbilirubinemia). Bilirubin at high levels is toxic to the cells of the brain – particularly the regions known as the basal ganglia and the brainstem. If left untreated, these high levels of bilirubin may cause severe and permanent brain injury.
Bilirubin is a yellowish byproduct of the breakdown of hemoglobin in red blood cells. Newborns have a higher rate of red cell breakdown with a level of bilirubin production leading to increased levels of bilirubin in the blood. High levels of bilirubin are deposited in the skin and the whites of the eyes causing a yellowing known as neonatal jaundice or jaundice of the newborn.
Jaundice is typically seen 2 to 3 days after birth. Under normal conditions (physiologic jaundice), the increased bilirubin peaks on day 3 or 4 of life and normalizes within 10 to 14 days. The bilirubin is converted by the baby’s liver into a form that can be removed by the body and the jaundice resolves without any complications.
Hyperbilirubinemia is defined as bilirubin levels above 5 mg per deciliter (dL). Jaundice is abnormal (pathologic jaundice) when the jaundice is not physiologic. Features of pathologic jaundice include the appearance of jaundice within 24 hours after birth, a rapidly rising total serum bilirubin concentration (increase of more than 5 mg per dL per day), and a total serum bilirubin level higher than 17 mg per dL.
Some babies have risk factors that cause the bilirubin to rise abnormally high either due to increased red cell breakdown or the inability of the liver to convert it to an excretable form, leading to toxic blood levels. When this occurs, the bilirubin is taken up by the brain leading to brain injury known as kernicterus. The condition resulting from kernicterus is called bilirubin induced neurologic dysfunction (BIND).
There are many risk factors that may lead a newborn to have hyperbilirubinemia. They may include conditions associated with the mother and those associated with the birth.
Maternal (parents) risk factors for Hyperbilirubinemia (either and/or both parents):
- Blood type incompatibility with baby (AB or Rh incompatibility)
- Breast feeding
- Certain drugs given to the mother such as diazepam (Valium), oxytocin (Pitocin), promethazine (Phenergan)
- Ethnic background – Asian, Native American, Mediterranean descent
- Gestational diabetes
- Genetic diseases of hemoglobin (thalassemias)
- Prior pregnancies with newborn jaundice
- G6PD Deficiency (a condition causing red blood cells to break down in response to certain medications, infections, or other stressors)
Neonatal (childs) risk factors for Hyperbilirubinemia:
- Birth trauma including bruising to the head
- Drugs given to the baby such as Pediazole or Chloromycetin
- Infections in the baby
- Polycythemia (increased red cells in the blood)
- Previous sibling with hyperbilirubinemia and/or newborn jaundice
- Male gender
- Liver disease
All newborns with jaundice should be evaluated with bilirubin levels. While in the hospital, routine assessment for jaundice should be every 8 to 12 hours. If the baby is discharged before 72 hours, they should be evaluated for jaundice within 2 days after discharge as the bilirubin levels may peak after the baby is discharged and jaundice missed.
If the baby is noted to be jaundiced, a bilirubin level should be obtained. Testing can be done with a blood sample for total serum bilirubin (TSB) or using a light to assess the bilirubin level (Transcutaneous bilirubin – TcB).
The risk for kernicterus is based on the bilirubin level and the baby’s age in hours using a chart known as a nomogram. Further testing is indicated based on the risk on the nomogram
Additionally, other laboratory tests should be obtained to determine whether the baby has risk factors for pathologic hyperbilirubinemia such as maternal fetal blood incompatibilities or genetic diseases of hemoglobin (thalassemia).
Missing jaundice and not properly monitoring bilirubin levels may lead to toxic levels of bilirubin and result in kernicterus.
If the bilirubin levels present a high risk for kernicterus, hyperbilirubinemia can be treated to prevent a rise to toxic levels:
- Phototherapy or light therapy – the baby is exposed to a special light that converts the bilirubin into a form that can be excreted by the body.
- Blood exchange transfusion – a baby’s blood is exchanged with blood from a matched donor.
In addition to having jaundice, babies with kernicterus may present with more severe signs. These include:
- Lethargy / excessive sleepiness
- High-pitched crying.
- Lack of appetite or difficulties feeding
- Floppy or limp body
- Absent reflexes e.g., the moro reflex
- Uncontrollable movements / muscle spasms
- Arching of the head and heels back (like a bow)
- Lack of wet diapers
- Unusual eye movements
Signs of Kernicterus often do not arise until a few months or years into a child’s life. This is usually because when a child has not reached expected milestones. If kernicterus is suspected as a cause of neurologic dysfunction, an MRI may demonstrate brain injury.
Kernicterus is preventable. If the risks of kernicterus are missed because bilirubin levels were not properly monitored and treated, the result will be severe and involve devastating complications. These include:
- Athetoid cerebral palsy – a movement disorder caused by brain injury
- Lack of muscle tone
- Muscle spasms
- Difficulty with coordination
- Problems maintaining normal eye movements
- Hearing and vision loss
- Developmental impairments
- Communication difficulties including speaking
- Intellectual and learning disabilities
- Poor development of the teeth
Kernicterus Lawyers Take Strong Action
Treatment to prevent kernicterus is readily available. The failure to identify this medical emergency is wholly avoidable. When allowed to go untreated, the result is a lifetime of disabilities, hardship, and long-term medical costs.
Healthcare professionals must be aware of the warning signs of excessive newborn jaundice. Failure to act quickly and properly may mean that they are liable for medical malpractice for harm suffered by the child because of their inaction.
Each family struggling with kernicterus has a unique story and set of challenges. We experience these struggles with them. For these families, our kernicterus injury lawyers work tirelessly to secure the financial compensation they so desperately need to offset their pain and suffering, and the massive costs of caring for a child with brain damage.
We believe in giving a powerful voice to those who would otherwise have none. We believe in seeking and speaking the truth. We crave justice.
Contact Ratzan Weissman & Boldt – National Kernicterus Malpractice Law Firm
If a doctor failed to treat your child for excessive jaundice that resulted in kernicterus-related brain damage, medical malpractice may have occurred. Our law firm can help you best determine how to proceed. When medical negligence is to blame, our attorneys will go to work immediately to build and pursue a powerful case on your child’s behalf.
To have your case reviewed, contact our kernicterus lawyers here or by telephone at 855-754-5291. It costs nothing to call and ask us to evaluate your case – we are here to help. We are a contingency-fee based practice. What this means is that there are no fees or costs to you unless we prevail through either a favorable settlement or jury verdict.Contact Us
Top Kernicterus Case Results
$18 Million Recovery for a Baby Who Developed Kernicterus as a Result of Untreated Jaundice
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