The Signs of Kernicterus or a High Bilirubin in a Newborn are Obvious. How Can Some Doctors Miss It?

Kernicterus means "yellow kern" which is indicative of the part of the baby's brain that is stained yellow. This yellowing occurs when a newborn develops hyperbilirubinemia or bilirubin encephalopathy. The sad thing is that kernicterus is a "never event" which means there is really no reason newborns should develop kernicterus but they still do. How does this happen?

If your newborn baby's bilirubin level is high, make sure the neonatologist, pediatrician, nurse practitioner or doctor is not making the following mistakes:

Not comparing the bilirubin level to the hour-specific norms.

Just looking at a bilirubin level is not good enough. What may be an acceptable bilirubin level for a three day old infant is not the same as what is acceptable for a one day old newborn. In addition, normal or acceptable bilirubin blood levels are different if the baby was premature or a full term infant. Most physicians will use the Bhutani Nomogram, although others may not.

Not believing the bilirubin lab result and delaying treatments until a repeat blood test is done.

If the bilirubin blood level appears to be inaccurate, it is perfectly fine for a physician to want to repeat it. However, while that is being done, your baby should be treated with light therapy, hydration or have blood ready just in case it is needed for an exchange transfusion. If the repeat blood test shows a safe bilirubin level, the treatments can be stopped.

Looking at the indirect (or unconjugated) bilirubin level instead of the total serum bilirubin result.

The total bilirubin level should be measured to make treatment decisions.

Allowing the bilirubin level to become dangerously high.

With transcutaneous bilirubin monitoring or serum blood tests, there is no excuse for not monitoring a baby's bilirubin level.

Interrupting phototherapy, light therapy or bili-lights

If your baby should require a sepsis work-up, lumbar puncture (LP) or spinal tap, echocardiogram, EKG or other test, they should be performed under bili-lights if possible. If your baby needs to be off of the unit for a test, the lights should go with them.

Not seeing that your newborn is showing neurological signs or signs of Kernicterus

Infants who develop brain damage from kernicterus will appear lethargic, tired or sleepy, have a high pitched cry, decreased muscle tone with episodes of increased tone, poor feeding and back arching.

High levels of bilirubin or untreated severe jaundice can cause permanent brain damage to your baby. When that happens, it is called kernicterus. If a newborn develops kernicterus they can be left with permanent brain injuries, developmental delays, cerebral palsy, deafness, seizures, or blindness. If your baby is yellow or jaundiced right after birth, make sure the doctors and nurses are following the above guidelines and express any concerns you may have with your child's neonatologist or pediatrician.

If your baby had a high bilirubin level at birth or was left with permanent brain damage due to kernicterus, please feel free to contact one of our experienced lawyers, doctors or neonatal intensive care unit (NICU) nurses at (215) 866-2424 for a confidential and free consultation or fill out our online contact form.