What Are Kernicterus Treatment Strategies

When excessive jaundice presents the threat of kernicterus, treatment strategies must begin immediately with phototherapy (light treatment). Often a baby’s new liver has not reached its full functional capacity. Phototherapy is used until the baby’s liver is mature enough to take over and manage the bilirubin levels on its own. Phototherapy for jaundice usually takes a few days, and is the most common form of treatment for the prevention of kernicterus.

To apply phototherapy, the baby is undressed and placed under special lights. A diaper may or may not be used, and the baby’s eyes are protected by opaque eye patches.

The intensity and spectral output of phototherapy lights used on jaundiced newborns plays a critical role in the effectiveness of kernicterus treatment. The only light wavelengths that produce therapeutic effects are those that penetrate tissue and are absorbed by bilirubin. Lamps with output in the 460 to 490 nm range – referred to as the blue to green region of the spectrum – are the most effective for treating dangerously high levels of bilirubin.

When the infant is placed under these lights, the baby’s skin and blood absorb the light waves. This causes the bilirubin molecule to break down into component parts that can be eliminated from the baby’s body more easily. Phototherapy is sufficient to bring the bilirubin levels back into a safe range most of the time.

As a key component in guarding against kernicterus, treatment providers and medical staff should be trained and able to assess the baby’s clinical status during phototherapy, and be attentive to and proactive about many things, including:

  • Ensuring proper feeding (often through a stomach tube) and hydration (often given intravenously) and temperature control of the infant
  • Assessing the improvement or progression of jaundice in the patient, including early signs of kernicterus such as inability to nurse, changes in sleep, or inconsolable crying.
  • The importance of safely reducing the distance of the phototherapy lights from the infant, and the effects of any physical factors that could interfere with or block the light source, or reduce exposure to the baby’s body.

How Does the Doctor Know When To Use Phototherapy for Jaundice?

Phototherapy becomes necessary when total serum bilirubin (TSB) reaches certain dangerous levels within hours of the baby’s life. To determine the need and duration of phototherapy as a preventive kernicterus treatment, kernicterus diagnosis is performed with a blood test for TSB. 

Phototherapy treatment lasts for several days for most newborns. Your baby's TSB level will be tested throughout phototherapy to determine when the bilirubin concentration reaches normal levels and phototherapy is no longer needed.

The early, rapid and accurate employment of phototherapy as treatment for hyperbilirubinemia should eliminate the need for further measures to prevent, or arrest, the onset of kernicterus.

“Last Resort” Kernicterus Treatment: The Exchange Transfusion

What happens when bilirubin levels do not respond to phototherapy? Perhaps the levels have gotten so high that intensive phototherapy cannot bring the bilirubin levels down to a safe range fast enough to ensure the prevention of brain damage. In these cases, exchange transfusion can be performed.

During the exchange transfusion procedure, the baby’s blood serum (containing high levels of bilirubin) is filtered out and replaced with ‘clean’ blood serum. This is done using a machine similar to that used for dialysis in patients with kidney disease.

As a precaution, and because timing is so critical, an attentive, proactive medical staff will already have the jaundiced baby blood typed, and have the appropriate blood ready, so the exchange transfusion can be performed at a moment’s notice.

Because the procedure is invasive and has the potential to cause serious complications, exchange transfusion is used only in cases of extreme emergency after phototherapy has failed or is found to be insufficient.

When Kernicterus Treatment Is Mismanaged

Mismanagement of elevated bilirubin in newborns can arise in many ways. This includes the inadequate administration of phototherapy treatment or exchange transfusions.

  • Was the baby properly screened and monitored to make certain that concentrations of bilirubin did not reach dangerous levels?
  • Did the hospital have and use standard operating procedures for the safe and effective use of phototherapy?
  • Did the doctors or hospital ensure that the phototherapy lights they used fully illuminated the baby’s body surface area?
  • Did the phototherapy lights operate at the right irradiance level, at the recommended “blue-to-green region” of the light spectrum?
  • Was phototherapy administered in time?
  • Did the hospital obtain blood in a timely manner for an exchange transfusion?

The damages caused by kernicterus are for life.

If something went wrong during your child’s birth, you want answers. If your child suffered brain damage, or you lost your child to kernicterus, you deserve absolute justice.

Ratzan Law Group can help you pursue and obtain justice. We dedicate our practice to revealing the truth when medical negligence has occurred, in order to secure the financial compensation you need to provide for your injured child, and to improve the safety and well-being of future children.

If you would like to have your case reviewed by our kernicterus attorneys, please call us for a free confidential consultation. 

More information on kernicterus treatment and prevention.