Jaundice in Newborns and the Risk of Kernicterus

The appearance of mild jaundice in newborns is common, and happens to almost 60 percent of babies within a few days after birth. However, when parents of healthy newborns suddenly find out their baby is jaundiced, they often do not know what is happening, and are not prepared for what may follow.

Any baby can get jaundice. The good news is jaundice is usually not harmful, entirely controllable, and severe complications are rare. Still, all parents should be aware of the standard of care required for jaundice in newborn babies.

Vigilant management of jaundice by neonatal doctors and nurses is critical in order to prevent associated complications. If undiagnosed and not properly treated, jaundice can develop into a neurological condition known as kernicterus. The result of kernicterus in newborns is irreversible brain damage, which can manifest as athetoid cerebral palsy, hearing impairments, vision and gaze defects, dental problems, and varying degrees of mental retardation.

What Causes Jaundice in Newborns?

We all have a waste product in our blood called bilirubin. When red blood cells die, they release bilirubin into the bloodstream. Elimination of bilirubin is handled by our livers and digestive tracts.

When a baby is born, its liver is not quite mature enough to efficiently process and eliminate bilirubin during the first week or two of life. Whereas the mother’s placenta was previously handling the removal of bilirubin, now the baby’s liver has to metabolize the bilirubin, which is then eliminated through the bowels. Until the baby’s liver adapts to the task, bilirubin can build up in their body beyond the normal limits. The medical label for excess bilirubin in the baby’s bloodstream is hyperbilirubinemia.

Bilirubin has a yellow pigment. A build up of bilirubin in the baby’s blood and tissues causes the yellow coloring of the baby’s skin and eyes. Jaundice (which means “yellow”) is the term used to describe this yellow discoloration.

Most jaundice in newborns is not dangerous. Yet when allowed to rise to very high levels, bilirubin is quite harmful to the baby’s brain. Simple tests performed by your doctor will determine if the levels are dangerous and require treatment.

If bilirubin levels in the bloodstream go unchecked, bilirubin can seep into the brain and destroy certain brain cells causing permanent brain damage. This is when kernicterus occurs. You can learn more about the link between jaundice in newborns and kernicterus here.

Newborn jaundice may also be caused or hastened by several medical conditions. Your doctor should discuss these risk factors for jaundice in your newborn with you, so you can be fully aware of each type of jaundice to which your baby may be susceptible.   

Common Types of Jaundice in Newborns

Physiological jaundice: This mild form of jaundice is often referred to as “normal” jaundice. It happens in most healthy newborns as a normal response to their still-developing liver’s limitations in processing bilirubin. As the baby’s liver matures and the production of bilirubin decreases, this type of physiological jaundice usually disappears in one or two weeks.

Jaundice in Premature Babies: Infants born prematurely (more than two weeks before their due date) are more susceptible to jaundice than full term newborns. Their livers and digestive systems are less developed and can have a harder time processing and excreting bilirubin. Doctors and hospitals should be highly prepared to monitor and treat jaundice in premature newborns to avoid complications of hyperbilirubinemia.

Breastfeeding jaundice: Jaundice in newborns can develop when a breastfeeding baby is not getting enough breast milk. This can happen if the baby doesn’t take to breastfeeding well, or perhaps the mother has a low milk supply at first. Remember, bilirubin is carried out of the body through the digestive tract. Without enough milk passing through their system, babies will not have the bowel movements they need. This can even lead to dehydration. Breastfeeding jaundice does not mean there is something wrong with the breast milk, but that the baby is not getting enough milk.

Breast milk jaundice: In rare instances, jaundice in newborns who are breastfed may be provoked by factors in the breast milk that slow the rate at which the baby’s liver can process bilirubin. This causes the bilirubin levels to rise. Breast milk jaundice starts after the first week of life and can last for up to six to twelve weeks. This type of jaundice in newborns may run in families.

Blood group incompatibility: There are two main types of blood type incompatibility between the mother and the infant. Both are reasons to track jaundice in newborns very closely.

 

  • ABO Incompatibility:  This form of jaundice happens when the mother has type O blood and her baby has blood type A or B. The mother’s O type blood has antibodies that work against the baby’s A or B type blood. This can make the baby’s red blood cells break down faster, which increases the bilirubin level in the baby’s bloodstream.
  • Rh Problems:  The other type of blood group incompatibility is when the mother has an Rh factor negative blood type, and the baby is Rh factor positive. Rh problems used to be a very common cause of severe jaundice in newborns. Now, Rh complications should be prevented by giving medication called Rhogham to the mothers. Newborns with complications of severe Rh incompatibility are at high risk for developing kernicterus brain damage.

Seek an Open Dialogue about Jaundice in Newborns

Has your doctor talked with you about the possibility of newborn jaundice occurring in your baby, and what you should expect? If he or she has not, we encourage you to ask about it. You need to know the facts about jaundice occurring, especially if your baby is born prematurely. Your physician should also be aware of your family history, as well as carefully discussing with you the implications and importance of proper breastfeeding.

What might start out as jaundice may end in kernicterus brain damage. Although kernicterus is a rare birth injury, one case is one child’s entire life. That is why jaundice requires skilled, deliberate attention from medical professionals to ensure that all possible steps are taken - 100% of the time - to prevent jaundice in newborns from elevating to dangerous levels.

A big question raised among parents is whether or not your child’s kernicterus was preventable. Our law firm believes in seeking and speaking the truth for families whose children’s lives have been needlessly and irreparably changed by kernicterus birth injury.

If you believe your medical team may have caused your child to suffer brain damage from kernicterus, please contact us. We offer support in many ways, and champion our client’s cases with utmost compassion as we seek the truth and find justice for them.

Find more  information at our Kernicterus Information Center.