Information on Kernicterus -

Kernicterus is damage to the brain centers of infants caused by increased levels of unconjugated-indirect bilirubin which is free (not bound to albumin). This may be due to several underlying pathologic processes. Newborn babies are often polycythemic, meaning they have too many red blood cells. When they break down the cells, one of the byproducts is bilirubin, which circulates in the blood and causes jaundice. Alternately, Rh incompatibility between mother and fetus may cause hemolysis of fetal red blood cells, thereby releasing unconjugated bilirubin into the fetal blood.

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. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion.

Kernicterus is the name given the disease where too much bilirubin in the blood causes brain damage. The name Kernicterus comes from two Greek words - kern which refers to a portion of the brain, and icterus, which means yellow. The brain is the part of the body most severely damaged by prolonged exposure to extra bilirubin in the blood. Severe damage to the brain can result in the child's death. If the baby lives, they may experience deficits such as cerebral palsy, mental retardation, or problems with vision and hearing.

Symptoms may include lack of energy (lethargy), poor feeding habits, fever, and vomiting. Affected infants may also experience the absence of certain reflexes (e.g., Moro reflex, etc.); mild to severe muscle spasms including those in which the head and heels are bent backward and the body bows forward (opisthotonus); and/or uncontrolled involuntary muscle movements (spasticity). In some cases, infants with kernicterus may develop life-threatening complications.

Early diagnosis and treatment of jaundice or conditions that lead to jaundice may help prevent this complication. The American Academy of Pediatrics recommends that infants with the first signs of jaundice have their bilirubin level measured within 24 hours. If the level is high, the infant should be screened for diseases that involve the destruction of red blood cells (hemolysis).

Normally, extra bilirubin is removed from the bloodstream by the liver and kidneys, and it leaves the body in urine and stool. During pregnancy, the mother's body removes the extra bilirubin for the baby. After birth, it takes a few days for the newborn's liver to get good at removing bilirubin from the blood. If you feed your baby every 1 to 3 hours, mild jaundice will usually go away on its own after a few days. But if your baby has any signs of jaundice, you and your doctor will need to watch him or her closely.

If jaundice continues to get worse and is not treated, bilirubin in the blood can build up to a high level. This is when kernicterus becomes a concern.
In some cases, kernicterus also causes problems with vision and teeth, and mental retardation. In newborn babies with kernicterus, 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 damage the brain.

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