How Are Kernicterus and Bilirubin Related?

To understand how kernicterus and bilirubin are related, we need to better understand what bilirubin is, and how it is processed in a baby’s body.

The body’s normal process of recycling old red blood cells includes eliminating the resulting by-products. One of these by-products is bilirubin.

For the newborn, this normal recycling process had previously been occurring in the womb. The mother’s body has taken care of the old red blood cells. Once born, a baby’s body must take over the process of elimination. The red blood cells have a lifespan of about 45-50 days in a newborn. The baby’s body now needs to pick up the on-going process of breaking the dead red blood cells down and eliminate the bilirubin.

A Baby’s Liver and Bilirubin Break-Down

Bilirubin has a characteristic yellow pigment, and is removed from the body in stool and urine. In fact, bilirubin is what causes the yellow or brown color to normal urine and stool. So the bilirubin must travel through the baby’s circulation to the liver. Once it arrives, the baby’s liver must be able to process the bilirubin so it can finally be excreted from the body.

Any condition that disrupts this process, at any stage in the process, can result in the rapid build-up of excess bilirubin in the baby’s body. This causes neonatal jaundice.

A newborn’s liver is immature. Sometimes, their livers cannot initially handle the chemical processes that need to happen for the bilirubin to break down. In addition, there may be events during birth that create even more dead red blood cells (creating more bilirubin). Some examples include a traumatic delivery that results in bruising, the blood types of the mother and baby are incompatible, sepsis (blood infection), or the use of oxytocin during labor.

Other situations can hinder the clearance of bilirubin, such as premature birth, G6PD deficiency, and other genetic or metabolic disorders. All work to increase bilirubin levels in the newborn. The failure of a doctor or nurse to take appropriate action in all cases of elevated bilirubin can lead to acute kernicterus, and may constitute medical malpractice.

Risk of Kernicterus: When Bilirubin Build-Up Leads to Extreme Jaundice in Newborns

It is common for an infant’s liver to take a few days before it is able to remove bilirubin from the blood. After the first week of life, the baby’s liver is generally able to work properly to keep the bilirubin levels within normal limits.

But what if the baby’s liver cannot? Next, we will explore how bilirubin levels can alert the doctor to the threat of kernicterus. The attending medical practitioners must be attentive to the situation and ready to provide the proper standard of care.


The attorneys at Ratzan Law Group crave justice for children who have suffered birth injury at the hands of negligent medical practitioners. We are ready and able to fight for justice on behalf of you and your child. If you have questions, please contact our kernicterus lawyers. We are here to help.

Kernicterus Information Center