Kernicterus

Kernicterus is a very rare type of brain damage that occurs in a newborn with severe jaundice. It happens when a substance in the blood, called 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 severe.

Kernicterus has likely already started if a baby has certain symptoms, including:

• Extreme sleepiness and lethargy. This means a baby is difficult to wake up from sleep or can't be kept awake. But keep in mind that newborn babies sleep a lot. Lethargy in a newborn is easy to confuse with normal newborn behavior. A lethargic baby does not eat well, does not respond to touching or does not startle from sudden movements, and never seems to fully wake up.
• A very high-pitched cry that does not sound normal.
• Poor muscle tone. The baby may seem "floppy" and weak. Sometimes this is followed by periods when the baby's muscles flex in a way that is not normal. The baby may be stiff and arch his or her back and head.
• A fever that occurs along with any of these other symptoms.

The lifelong damage from kernicterus may cause long-term:

• Movement problems. A baby may develop slow and uncontrolled movements or random, jerky movements.
• Hearing loss or deafness. Some babies may seem to have normal hearing, but they develop a problem processing sounds. This is called auditory neuropathy or auditory dyssynchrony.
• Learning problems and other developmental disabilities.
• Problems moving the eyes, especially looking upward.

Kernicterus may cause stains on the outside (enamel) of a child's baby teeth (primary teeth).

Your doctor diagnoses kernicterus through a physical exam and knowledge of your child's history of symptoms. Blood tests to measure your baby's bilirubin levels are also done. 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.

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 physical therapy, speech therapy, and special education.

Work with your doctor on ways to care for your child at home. Go to any follow-up appointments for testing and treatment. It may help to learn more about the condition.