Kernicterus: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Kernicterus is an uncommon condition also known as  "bilirubin encephalopathy" which affects the brain and can develop in your baby if they have hyperbilirubinemia (excess bilirubin in the blood). The yellow waste substance bilirubin is produced by your body.

Sometimes your liver is unable to get rid of enough bilirubin to keep you healthy. An elevated bilirubin level may cause jaundice. Your skin, eye whites, gums, and mucous membranes around your tongue all seem yellow when this occurs.

The signs of kernicterus appear gradually. Jaundice is simply one of the symptoms that infants frequently experience; others include irritability, poor feeding, and convulsions. Complications could lead to permanent brain damage and hearing loss. If you see any changes in your baby's attitude or look, call their doctor right away.

Causes Of Kernicterus

Kernicterus is brought on by hyperbilirubinemia, or extremely high bilirubin levels in the blood. This occurs when your newborn's liver cannot eliminate enough bilirubin.

There are several potential causes of hyperbilirubinemia.

• The overproduction of red blood cells which is known as polycythemia- Red blood cells are destroyed by your body during hemolysis. This happens naturally as part of a cell's lifespan. Your body occasionally destroys cells too quickly or more frequently than expected.
• Injury during birth- Your infant could suffer from a birth injury such as a cephalohematoma, a subgaleal hemorrhage, or bruises.
• The disorder that affects your child's liver, such as Crigler-Najjar syndrome, or a condition that affects your child's blood cells, like Rh hemolytic disease.
• Bilirubin builds up in your blood and then travels to the tissue of your brain when your liver is unable to eliminate it through your feces. Serious consequences can result from bilirubin in the brain.

Symptoms Of Kernicterus

Jaundice symptoms can start to show up in a newborn's first few days of life. The baby's skin and eye whites turn a yellowish color due to jaundice. The symptoms of kernicterus are more severe.

Additionally infants are lethargic with kernicterus. They are therefore unusually exhausted. All newborns sleep a lot, but drowsy infants sleep even more, and are difficult to wake up. When they do awaken, they frequently immediately go back to sleep.

Other kernicterus signs and symptoms include:

• Crying with a loud voice
• Reduced appetite and feeding less frequently than usual, and uncontrollable crying
• Missing reflexes
• A floppy or limp body
• Uncontrolled movements
• A bow-like arch in the back of the heels and head.
• Unusual eye movements
• Vomiting
• Lack of dirty or wet diapers
• Fever
• Convulsions

Risk Factors Of Kernicterus

 Your infant has a higher chance of developing kernicterus if the following conditions are present:

• Having jaundice as a newborn.
• Have a darker skin tone because the condition's initial symptom,that is yellowing skin will be hard to spot.
• Were born earlier than 37 weeks of pregnancy.
• Are not eating well, which prevents them from pooping to eliminate bilirubin.
• Possess a biological family history of neonatal jaundice.
• Even healthy kids can get jaundice. Kernicterus may result from severe jaundice.

Diagnosis Of Kernicterus

A physical examination and testing are used to determine the diagnosis of kernicterus. Here are two tests:

• Light meter test.
• Blood tests for bilirubin.

A light meter is a tool that shines a medical-grade light on your infant's skin. Based on how the light reflects off your baby's skin and onto the instrument, it determines the level of bilirubin in the blood.

An expert in medicine will conduct a bilirubin blood test to validate a diagnosis. A little sample of blood from your newborn's heel will be drawn for this test by a medical professional. Your child's body will be tested at a lab to find out how much bilirubin is present there.

It is not necessary to have imaging tests like a head ultrasound, CT scan, or MRI, but they may assist exclude other illnesses that have similar symptoms.

Treatment Of Kernicterus

The goal of treatment is to reduce unconjugated bilirubin levels in a newborn's body before levels that cause kernicterus.

Infants who have elevated bilirubin levels are usually treated with phototherapy, also referred to as light therapy. During this process, the infant's naked body is exposed to a certain light. In response to light, the baby's body degrades unconjugated bilirubin more quickly.

Babies who have blood bilirubin levels that are exceptionally high may need a blood exchange transfusion. During this procedure, a small sample of the infant's blood is extracted. Then it is changed with blood from a matching donor.

A further method for treating excessive bilirubin levels is to offer your infant more feedings. Through the intestines, faeces carries bilirubin away. Babies that consume more produce more excrement, which results in a greater removal of bilirubin.

Complications Of Kernicterus

These issues can arise in newborns with kernicterus:

• A form of mobility disability brought on by brain damage is called athetoid cerebral palsy.
• Muscular spasms due to a loss of tone
• Difficulty coordinating movement
• Hearing loss and deafness
• Difficulties with eye movement, such as difficulty looking up
• Difficulty in speaking,
• Intellectual limitation
• Stained baby teeth

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