What is Kernicterus? Is your baby at risk?

If you are a new mother or father, I know how worried you are about your little one. Sometimes you may be scared to see your baby's skin turning yellow. This is called jaundice. Most of the time, it is not serious, but sometimes, if this jaundice gets worse, it can cause damage to the baby's brain. That is what we are talking about today, which is called kernicterus.

What is Kernicterus?

Simply put, Kernicterus is a rare condition that occurs when your baby's blood contains too much of a yellow substance called bilirubin (we call this hyperbilirubinemia), which can damage the baby's brain.

Now you may be wondering what this bilirubin is? It is a yellow waste product that is formed when red blood cells in our body break down. Normally, our liver removes this bilirubin from the body. But sometimes, especially in newborn babies, the liver is unable to remove it properly. Then bilirubin accumulates in the blood, causing the baby's skin, the whites of the eyes, gums, and the mucous membranes under the tongue to turn yellow. That is what we call jaundice .

Kernicterus symptoms develop gradually. In addition to jaundice, newborns may experience irritability, refusal to breastfeed, and seizures. If the condition becomes severe, the baby may lose hearing and may even suffer permanent brain damage. So if you notice any changes in your newborn's behavior or appearance, you should see a doctor right away.

You may have heard that sometimes doctors refer to this condition as 'Bilirubin Encephalopathy'.

How common is Kernicterus?

Jaundice is very common in newborns. However, doctors are always vigilant about newborn jaundice, which reduces the risk of it developing into kernicterus. That is why kernicterus is a very rare condition.

Although this mostly affects newborn babies, it can also occur in adults in very rare cases.

What are the symptoms of Kernicterus?

The first sign of kernicterus is jaundice . If your baby has jaundice, the following areas will appear yellow:

• Baby's skin.
• The white part of the eyes.
• The delicate membranes inside the mouth (such as the gums and under the tongue).

Doctors can diagnose this condition within one to three weeks after the baby is born.

In addition to jaundice, kernicterus may also have these symptoms:

• Lethargy , drowsiness.
• Fever.
• Vomiting.
• Involuntary muscle movements.

These symptoms may vary depending on the severity of the condition, that is, the different stages of kernicterus.

Stages of Kernicterus

There are three main stages of kernicterus. Symptoms are different in each stage.

• Early stage: Difficulty feeding and sucking, drowsiness, low muscle tone, reduced startle reflex . Imagine, the baby is just lifeless.
• Middle stage: irritability, loud screaming, sometimes high-pitched crying, high muscle tone. The baby seems to be simply restless.
• Late stage: Milk feeding stops completely, the body muscles become stiff, the body is arched back with neck bent backward, and convulsions occur. This is the most dangerous and life-threatening stage .

If your baby has jaundice and other symptoms mentioned above, you should see a doctor without delay.

What are the causes of Kernicterus?

The main cause of kernicterus is hyperbilirubinemia , which occurs when a newborn's liver is unable to properly remove bilirubin.

There are several reasons why bilirubin can increase in this way:

• Polycythemia: This means an excessive increase in the number of red blood cells in the body.
• Hemolysis: This is the destruction of red blood cells. This usually happens as part of the cell's life cycle. However, sometimes these cells can be destroyed too quickly or excessively.
• Injuries during birth: When a baby is born, there may be a collection of blood under the skin of the head (cephalohematoma) , bleeding between the skin and the skull (subgaleal hemorrhage) , or bruising.
• A medical condition that affects the baby's blood cells: For example , Rh hemolytic disease , or a condition that affects the baby's liver, such as Crigler-Najjar syndrome .

When the liver is unable to excrete bilirubin in the stool, it builds up in the blood and then travels to brain tissue. If bilirubin gets to the brain like this, it can cause serious complications.

What are the long-term effects and complications of Kernicterus?

Complications caused by kernicterus can sometimes be life-threatening and can have long-term effects. They include:

• Hearing loss.
• A condition called cerebral palsy .
• Problems with cognitive development .
• Permanent brain damage.
• Coma.

These are scary things to hear. But remember, these serious conditions can be prevented if diagnosed and treated early.

Who is at higher risk of developing Kernicterus?

Your newborn baby may be at increased risk of developing kernicterus if:

• If the newborn baby has jaundice.
• If the baby's skin color is a bit darker, it may be difficult to recognize the yellowing of the skin (which is the first sign of this condition). This is something you should be especially careful about.
• A baby born before 37 weeks is called a preterm baby.
• If you don't eat properly, you won't be able to defecate properly (bilirubin is excreted from the body with feces).
• If someone in the family has had jaundice during infancy (biological family history).

Even healthy babies can develop jaundice. However, if the jaundice becomes severe, it can lead to kernicterus.

How is Kernicterus diagnosed?

A doctor usually determines whether a baby has kernicterus by performing a physical exam and some tests. Two main tests are performed:

• A light meter test: This involves shining a light on your baby's skin with a special device. The way the light bounces off the baby's skin and back to the device is used to calculate the bilirubin level. This is a painless and easy test.
• A bilirubin blood test: To confirm the diagnosis, a doctor will take a small blood sample from your baby's heel, send it to a lab, and measure the amount of bilirubin.

Sometimes, things like an ultrasound scan of the head, a CT scan , or an MRI scan may be done. But they are not necessary. They are just to make sure there are no other conditions that have similar symptoms.

What is the bilirubin level that causes kernicterus?

A doctor will measure the level of Total Serum Bilirubin (TSB) in your baby's blood to check for kernicterus. Normally, TSB levels should be between 0.1 and 1.2 mg/dL (milligrams per deciliter). Symptoms of jaundice begin to appear when TSB levels reach around 2.0 mg/dL. A TSB level of 25 mg/dL or higher is considered very high and is considered kernicterus. If you have any concerns about the test results, ask your doctor.

How is Kernicterus treated?

There are several treatments for kernicterus. The doctor will determine the most appropriate treatment based on the baby's condition.

• Phototherapy: This involves shining bright ultraviolet lights on the baby's skin. These lights are medically safe and do not harm the baby. The baby is placed in a bed and the light is directed at the baby's skin. The baby's eyes are covered during the treatment. This light changes bilirubin so that it can be easily excreted from the body.
• Exchange blood transfusions: This involves removing the baby's own blood and replacing it with blood and/or plasma from a donor. A doctor inserts a small tube into a vein in the baby's arm or a catheter into the umbilical stump. This is done to quickly reduce the amount of bilirubin in the blood.
• Intravenous Immunoglobulins (IVIG): If your baby has high bilirubin levels due to a condition such as Rh disease, a doctor may give IVIG. This is an antibody therapy. It is given as a saline solution into a vein in your baby's arm.

These treatments may sound a little scary, but it's important to remember that they are being done to save the baby from a serious condition.

How long does it take for a baby to recover after treatment?

It can take up to two weeks for the baby to recover. However, if the baby's condition is in the late stages and the brain has been damaged, the damage may not be reversible. If that happens, there are treatments and support available to help the baby cope with the condition as they grow older.

You can help your baby recover quickly by feeding him well. A baby with kernicterus may have difficulty breastfeeding. Your doctor will advise you on how to provide the baby with the necessary nutrition. Your baby needs to be well-fed so that he can poop properly. It is through pooping that waste products like bilirubin are removed from the body.

What is the outlook for Kernicterus?

If your baby is treated in the early or middle stages of kernicterus, they can make a full recovery. However, babies with later stages of kernicterus can develop life-threatening complications. Talk to your doctor to learn more about your baby's condition.

Most of the time, doctors detect and treat jaundice in newborns before it becomes severe and turns into kernicterus. That's why kernicterus is a very rare condition.

Can a baby fully recover from kernicterus?

Yes, if diagnosed and treated early, a baby can fully recover from kernicterus. However, the baby's recovery rate depends on the stage of the condition and the factors that caused it.

Can Kernicterus be prevented?

There is no way to prevent all causes of kernicterus. But you can reduce your baby's risk of developing kernicterus by doing the following:

• Always be on the lookout for jaundice after your baby is born. If you see any yellow discoloration anywhere on your baby's body, see a doctor immediately.
• Don't miss your newborn's follow-up appointments. These are especially important if your baby was born prematurely.
• If your baby has jaundice, seek treatment under the guidance of a doctor. The doctor will advise on treatment if necessary.

The most important thing is to tell a doctor if you notice even the slightest change in your baby's appearance or behavior, without ignoring it.

When should I take my baby to a doctor?

If your newborn baby's skin, the whites of their eyes, or the inside of their mouth appear yellow, it's important to see a doctor within the first few weeks of birth. Jaundice is common in newborns, but high bilirubin levels can be life-threatening. A doctor will examine your baby and check their bilirubin levels to make sure they're healthy.

When should I take my baby to an emergency treatment unit (ETU) ?

If your baby has jaundice and other symptoms of kernicterus, such as seizures, call 911 immediately or take your baby to the nearest emergency room. Other signs to watch out for in an emergency include:

• If the baby bends his body like a bow, tilts his head back, and makes a "C" shape with his body.
• If you cry non-stop, or scream in a high-pitched voice.
• If the meatballs are unusually hard, or if the meatballs seem weak.

At times like this, it's important to act quickly and not panic.

What questions should I ask my baby's doctor?

Never be afraid to ask your doctor anything you have in mind about your baby. Here are some questions you can ask:

• How often should a newborn baby have medical checkups?
• What stage of kernicterus does my baby have?
• Are there any side effects of the treatment?
• How often does my baby need phototherapy?
• Has Kernicterus affected my baby's brain or caused any long-term complications?

As a parent of a newborn, it's normal to feel scared when your baby's skin and eyes turn yellow. It's also hard to watch your baby show symptoms that you can't control or fix. While jaundice is very common, kernicterus – a serious complication of jaundice caused by too much bilirubin in the baby's blood – is not so common. If you feel something is wrong, see your baby's doctor and speak up for your baby. Although complications can occur after kernicterus, there are lifelong supports to help your baby grow. If diagnosed and treated early, your newborn can recover.

Brief points to remember

Okay, so let's review the most important things we've talked about about Kernicterus.

• Kernicterus is a rare but dangerous condition that can cause brain damage when the level of bilirubin in the blood of newborn babies increases too much.
• The main early sign of this is jaundice - a yellowing of the skin and eyes.
• In addition to jaundice, if your baby is sleepy, refuses to breastfeed, is irritable, has a stiff body, or is having seizures, see a doctor immediately.
• If diagnosed and treated early (such as phototherapy and exchange transfusion), the baby can be completely cured. If left too late, permanent brain damage can occur.
• Be careful about jaundice after the baby is born. Follow the doctor's instructions.
• If you have any doubts, never hesitate to talk to a doctor. You are your baby's best protector.

I hope this information is useful to you. We wish you and your little one good health!

` Kernicterus, Bilirubin, Jaundice, Newborns, Brain Damage, Hyperbilirubinemia, Baby Health