Understanding Kernicterus and Bilirubin Levels

How Kernicterus is Directly Related to Bilirubin Levels in the Newborn

As a baby grows in the womb, the mother’s placenta performs many functions. It feeds and nourishes the developing baby, as well as removes waste and byproducts. One of these byproducts is bilirubin. The placenta extracts the bilirubin from the infant so it can be processed by the mother’s liver.

Suddenly the baby is born, and has to handle the bilirubin on its own. Babies often have trouble with this process. During this time, the bilirubin levels become mildly elevated in the newborn baby. Most infants overcome these difficulties without any treatment.

But sometimes the newborn’s body makes more bilirubin than it can process, or the baby’s liver cannot adjust to handle the bilirubin. Some babies can be identified as being at a greater risk of kernicterus. In all of these cases, the bilirubin levels in the baby’s blood become increasingly elevated.

Newborns with High Bilirubin Levels Can Be Effectively Treated

Kernicterus can be prevented by frequently monitoring infants and treating high bilirubin levels early, before it becomes severe. At the first signs of elevated bilirubin (jaundice), the proper tests to measure kernicterus and bilirubin levels must be performed.

What about babies that show no signs of jaundice? The American Academy of Pediatrics recommends that all babies be checked for jaundice before they leave the hospital. Many hospitals test all newborns at about 24 hours of age. Still, across hospitals and organizations throughout the country, opinions are divided on the use of universal screening for bilirubin.

Bilirubin Levels Indicate When Treatment is Needed

Eliminating the threat of kernicterus and high bilirubin is not complicated. Accurate and timely testing of the baby’s blood – considering the infant’s precise age in hours - gives a clear indication of what the concentration of bilirubin is and if preventive kernicterus treatment is required. 

A newborn’s total serum bilirubin (TSB) concentration is measured in milligrams per deciliter of blood, or mg/dL. The exact bilirubin level associated with kernicterus is unpredictable, and parameters can vary. A general guideline is provided below for when treatment is indicated:

  • Jaundice in a full term infant fewer than 24 hours old is always critical and should be treated aggressively;
  • the TSB concentration rises above 15 mg/dL within the first 48 hours of life;
  • the TSB concentration rises above 18 mg/dL in 48-72 hours;
  • the TSB concentration rises above 20 mg/dL in 72 hours and beyond.

Indeed, if the doctor has any reason for concern, phototherapy can be initiated earlier and at lower serum bilirubin levels. This is especially true when treating infants at greater risk for developing high bilirubin levels and kernicterus. In these cases, bilirubin levels that may not cause alarm in low-risk babies should be considered dangerous and treated aggressively.

Only In the Absence of Treatment Will Bilirubin Levels Evolve into Kernicterus

Treatment for lowering bilirubin levels is highly effective. Left unchecked, severe bilirubin buildup will move from the blood into the infant’s brain. This is the moment when kernicterus begins to occur, and brain damage results.

All of the information above is widely known and accepted in the medical community. The cost of not diagnosing elevated bilirubin levels and failing to prevent kernicterus is unjustifiable.

The malpractice attorneys at Ratzan Law Group firmly believe in seeking and speaking the truth. When bilirubin levels are allowed to elevate, children pay the price. For these families, we crave and pursue justice. You should not have to bear the costs alone. Negligent doctors, medical staff and hospitals must be held accountable for the lifetime of disability your child will endure.

If you have questions or concerns about initiating a birth injury claim, please schedule a consultation with our kernicterus attorneys


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