(Updated June 2020)
Kernicterus is a serious brain injury that can result from elevated bilirubin levels (jaundice). Jaundice can make an infant’s skin and eyes appear yellow, and if it is not treated in a timely manner the excess bilirubin can damage the brain.
Spotlight on Kernicterus Center of Excellence
Dr. Steven M. Shapiro, MD, MSHA, FAAP is the director of the Kernicterus Center of Excellence at Children’s Mercy Hospital in Kansas City (1). This is the only center of its kind in the U.S. Dr. Shapiro has been researching kernicterus since 1982.
Dr. Shapiro explains that roughly 60-80% of newborns in the U.S. are born with jaundice. When the bilirubin levels get too high, babies can be treated to lower them. Phototherapy (light treatment) is most commonly used in these cases to lower bilirubin levels.
If bilirubin levels are too high, or in cases of Rh disease or other hemolytic diseases, a blood transfusion is used to remove the toxic bilirubin from the blood (1).
When acute kernicterus occurs, the bilirubin levels are too high and are starting to cause injury in the brain. This is a medical emergency and must be treated properly and immediately. This must be treated with triple-bank phototherapy lights put as close to the baby as possible. The baby will need to be hydrated and fed via tube feedings, and a blood exchange transfusion should be promptly given (1).
Kernicterus and medical negligence
It is very important for physicians to remember that when clinical signs for bilirubin induced neurological damage occur, it is not too late to treat the baby. This is because when an infant is jaundiced and signs are present, damage is continuing to occur. The sooner the bilirubin is reduced, the better. Hyperbilirubinemia is a medical emergency, and delay makes damage worse. Brain damage from kernicterus can cause cerebral palsy and intellectual disabilities and developmental delays.
Negligence that can result in a baby developing kernicterus includes the following (1, 2):
- Not believing the bilirubin level from the lab and delaying treatment while it is repeated.
- Postponing treatment or interrupting phototherapy for diagnostic testing to determine the risk of an exchange transfusion.
- Failing to timely perform an exchange transfusion.
- Failing to examine the baby for signs of acute kernicterus, which include lethargy, decreased feeding, extremely tense muscles, limp body, a high-pitched cry, spasmodic torticollis, setting sun sign, fever and seizures.
- Using the indirect (or unconjugated) bilirubin instead of the total serum bilirubin to make treatment decisions. Total bilirubin level should be used.
- Letting the bilirubin reach potentially dangerous levels.
- Measuring the bilirubin and failing to compare it to hour-specific norms. This is very important. A bilirubin level in a one-day-old may be normal or dangerously high, depending on whether the baby is 24 or 47 hours old.
- The physician caused or contributed to the jaundice through improper use of forceps or a vacuum extractor at birth.
- The hospital was unreasonably negligent in not having policies on when to check bilirubin levels, especially in premature babies and other at – risk infants.
- The physician failed to obtain informed consent for any procedure, including method of giving birth and use of forceps or vacuum extractors.
When physicians and the medical team act negligently and fail to follow standards of care in diagnosing and treating high levels of bilirubin, it is negligence. If this negligence causes cerebral palsy or other neurological damage in a baby, it is medical malpractice. In addition, if the physician causes the baby to have hyperbilirubinemia, and this leads to brain damage and cerebral palsy, medical malpractice occurred.
The nationally recognized lawyers at ABC Law Centers (Reiter & Walsh, P.C.) have many years of experience in kernicterus cases. If your baby had jaundice and suffers from cerebral palsy, intellectual and developmental delays or other injuries, we can help you. Our skilled attorneys have decades of experience in kernicterus and cerebral palsy cases and will work tirelessly to obtain the compensation you and your family deserve. Contact us 24/7 via our live chat. We do not charge any fees for the entire legal process unless we win.
- Shapiro, S. M., MD. (n.d.). Kernicterus Center of Excellence. Retrieved June 19, 2020, from https://www.childrensmercy.org/departments-and-clinics/neurology/kernicterus-center-of-excellence/
- What Are Jaundice and Kernicterus? 26 Nov. 2019, www.cdc.gov/ncbddd/jaundice/facts.html.