Kernicterus and Cerebral Palsy

Kernicterus (also known as bilirubin encephalopathy) is a rare form of preventable brain damage that can occur in newborn babies with jaundice. Babies affected by kernicterus can have life-long complications and have various long-term medical problems. This is often a result of medical error.

Families of babies who have been impacted by kernicterus almost always have grounds for a medical malpractice lawsuit and should obtain advice from medical malpractice lawyers  who have many years of experience representing clients injured by negligent health care professionals.

Jaundice and Kernicterus

Jaundice is a condition in which a newborn baby’s skin and the whites of their eyes turn yellow. This is due to high bilirubin levels (also known as hyperbilirubinemia). Bilirubin is a brownish-yellow substance produced when red blood cells break down. Where too much bilirubin is produced, or where the liver cannot get rid of bilirubin quickly enough, jaundice can result.

Jaundice is very common in newborns and generally presents itself between 1 and 4 days after birth. At least 50% of all babies exhibit some degree of visible jaundice after birth. Most jaundice is not harmful and will disappear on its own. However, bilirubin at high enough concentrations is a toxic to the brain (neurotoxicity). Therefore, when bilirubin levels remain too elevated and are not treated properly or addressed quickly enough, the condition escalates to kernicterus and causes brain damage. In some cases, this can cause seizures, or result in loss of hearing, cerebral palsy, or serious developmental delays.

Symptoms of High Bilirubin Levels

When a baby first develops jaundice, the change in their skin tone generally appears in their face first. As bilirubin levels continue to rise, the discolouration may move to the chest, stomach, and arms and legs.

Visual jaundice or a change in colour is not always sufficient to signal to a physician or other medical practitioner that a newborn’s bilirubin is rising. Newborn babies should be carefully monitored. In most hospitals, bilirubin levels are routinely tested and measured before a newborn is released to go home. This can be done through either blood type testing and testing for Rh incompatibility (known as a Coomb’s test), or a trans-cutaneous bilirubinometer (a less invasive method than blood testing) by putting a handheld scanning device on the baby’s skin.

Parents should be provided with test results when the baby is released. If the test establishes that a newborn’s bilirubin levels may reach a level that will require medical treatment, a follow-up visit should be scheduled.

Babies at Higher Risk

Some newborns are at a higher risk of developing complications related to jaundice. These include:

  • Babies born before 37 weeks;
  • Babies who weigh less than 5.5. pounds at birth;
  • Babies whose blood type is not compatible with their mother’s blood type (Rh disease);
  • Babies with diabetic mothers;
  • Infection, sepsis or poor liver function;
  • Babies who develop jaundice within the first 24 hours; and
  • Babies who have bruising or swelling under their scalp after birth (known as “caput”).

Treatment of Jaundice

While hyperbilirubinemia cannot be completely prevented, early recognition and prompt treatment are critical in preventing bilirubin levels from rising to a dangerous stage.

Treatment for hyperbilirubinemia varies and will depend on a variety of factors, including the cause of the hyperbilirubinemia and the levels of bilirubin. Treatment options include:

  • Phototherapy (i.e. light therapy): this reduces bilirubin concentrations by metabolizing the bilirubin into a harmless substance that the body then eliminates. This can be done using special blue spectrum lights or a fiberoptic blanket;
  • Exchange Transfusion: this involves alternating between withdrawing a baby’s blood and giving a baby blood in small amounts and essentially washes bilirubin out of the blood. This treatment is reserved for situations in which there is sufficient concern that the child’s brain is at risk; or
  • Treating any underlying cause of hyperbilirubinemia, such as infection.

Symptoms of Kernicterus

Symptoms of kernicterus will vary from newborn to newborn, but may include:

  • Drowsiness or a lack of energy;
  • Fever;
  • Trouble feeding;
  • Limpness or stiffness of entire body;
  • Muscle spasms or reduced muscle tone;
  • Unusual eye movements; or
  • Uncontrollable or very shrill crying.

Kernicterus and Brain Damage

There are three different classifications of kernicterus (bilirubin encephalopathy):

  • Acute bilirubin encephalopathy (ABE): this occurs where bilirubin levels are so high they cross the blood-brain barrier and cause brain damage. If this is not treated immediately, ABE will progress to chronic bilirubin encephalopathy;
  • Chronic bilirubin encephalopathy (CBE): is permanent and occurs when ABE is not properly recognized or treated, resulting in severe brain damage. CBE can cause cognitive impairment, visual abnormalities, dental abnormalities, an impaired digestive system and cerebral palsy;
  • Subtle bilirubin encephalopathy (SBE): is a chronic condition that includes learning disorders, movement disorders, neurological disorders and hearing impairment.

Hyperbilirubinemia is simple to detect and to treat. No newborn should develop complications from untreated levels of bilirubin. Where such complications do occur, the parents of a child affected can seek damages (i.e. compensation).

If you have questions about the medical care your baby received after birth, or if you suspect that something out of the ordinary or abnormal may have occurred, contact the respected and highly knowledgeable Toronto medical malpractice lawyers at Sommers Roth & Elmaleh. We have been involved in many precedent setting decisions and have a proven track record of success.  Call us at 1-416-961-1212 or contact us online for a free consultation.

 

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