Kernicterus-Symptoms|Causes|Treatment and Prevention

 What is Kernicterus? 

Kernicterus is a rare, preventable yet serious complication of newborn jaundice that can damage the brain. 

It is also called bilirubin encephalopathy in medicine. "encephalon" refers to the brain and "pathy" refers to the disease or abnormal/pathological condition. Bilirubin has neurotoxic properties when it is elevated more than the normal or mild level range.

Kernicterus is the abnormal yellow staining of certain areas of brain such as brain stem and other surrounding areas.  icterus means yellow.

Jaundice is the yellowing of the skin, eyes and mucus membranes of the body due to the high levels of a substance called bilirubin in the blood.  Jaundice can happen in both babies and adults. The newborn babies have jaundice from day 2 to 4 and it may extend up to a week.  The type of jaundice in newborn babies is usually a common physiologic change due to the immature liver.  It settles down as the liver starts functioning well by the end of 3rd week of newborn's life. 

Kernicterus is a bilirubin induced neurological damage and a sign that the bilirubin levels are reaching above higher levels, and it is an indication of brain damage. 

See more: Jaundice in infants or Neonatal Jaundice

In adults the jaundice has the same presentation with yellowish discoloration of the skin, sclera and mucus membranes but it may be somewhat concern-able as it can be a result of some liver dysfunction or other medical conditions. 

It is usually not treated but the treatment of underlying cause and dietary changes are recommended to get relief from the symptoms of jaundice. 

See more: Jaundice in adults

Do adults get kernicterus? 

No, Kernicterus almost never happens to adults, even though the high levels of bilirubin are present, the chances of having kernicterus are not so likely. 

Kernicterus is a serious complication seen in infants and children. It may remain undiagnosed for years after birth and at the potential adverse effects may be seen in later ages when the gross motor and sensory functions are affected. 

Who is at more risk of having kernicterus?

Kernicterus is seen in newborns. The babies at more risk are:

• The preterm or the premature babies
• Babies with untreated jaundice
• Babies with pathological jaundice
• Babies with Rh incompatibility

What are the causes of Kernicterus and infants? 

Kernicterus can happen in both infants and adults.  However, the complication is very rare and affects only a minute population.  The causes are undiagnosed jaundice, untreated jaundice or delayed treatment of jaundice. 

In both cases, the bilirubin levels are not regulated and this has a bad effect on the brain. 

The damage caused by kernicterus is usually permanent as the changes cannot be reversed. Only the symptoms can be relieved by initiating treatment before it gets too late. 

What are the signs and symptoms of kernicterus?

The signs and symptoms of kernicterus in infants are:

• Symptoms of jaundice become severe in kernicterus
• Hyperbilirubinemia or elevated levels of serum bilirubin. 

This aggravation in the symptoms of jaundice may be accompanied by the initial symptoms of kernicterus such as:

• Incomplete or poor feeds by baby
• Baby looks lethargic
• Irritability and extreme fussiness, high-pitched crying 
• Baby looks either sleepless or difficult to awake once slept
• Decreased muscle tone
• Abnormal muscle rigidity, arched body
• Muscle spasms, unusual movements of the eyeballs
• Absence of Moro reflex in neonates
• Low urine output as of less dirty diaper counts 

With more progression the symptoms become more severe in later childhood leading to:

• Athetoid palsy
• Hearing loss 
• Disturbed sensory and motor development
• Visual changes
• Teething delayed and disturbed
• Intellectual abilities of the baby may be hampered.

How can Kernicterus be diagnosed in newborn or infants? 

In medicine there is kernicterus can be diagnosed presumptively by testing the serum bilirubin levels.  In kernicterus the level of unconjugated biliurbin in serum may reach higher than 25 mg/dL.  Hyperbilirubinemia helps in making an assumption that it may be kernicterus.  It can further be supported by examining the substantial changes in the neurologic tests. 

What is the treatment of Kernicterus?

The treatment is usually the same as that of severe newborn jaundice such as exchange transfusions, phototherapy and immuoglobulins.  It can only be treated medically by treating the condition called hyperbilirubinemia. 

Is kernicterus preventable? 

Prevention of kernicterus:

Early diagnosis and treatment of newborn jaundice is the best preventive measure to prevent the development of kernicterus in the baby. 

Kernicterus is a rare yet serious complication of untreated or unmanaged newborn jaundice and it may cause severe disturbances in the baby's gros sensory and motor development. It can be prevented by early diagnosis and prompt treatment of newborn jaundice.

See more on : Newborn or Infant jaundice.

Note: This post is for informational and educational purpose only, It is not a substitute to any medical or professional advice or treatment. See your doctor in any case.