Kernicterous Medical Negligence
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Hyperbilirubinaemia is a common condition of newborns, including those that are otherwise healthy. If severe and untreated or poorly treated, the bilirubin can become deposited into the brain, causing brain damage called kernicterus which can cause a form of cerebral palsy that results in uncontrollable movements of the body, face, legs and arms, called athetoid cerebral palsy.

Medical Negligence Solicitors


Our medical negligence solicitors deal with personal injury compensation claims arising from medical negligence by a healthcare practitioner involving kernicterus and hyperbilirubinemia. Our solicitors deal with compensation claims using the no win no fee scheme. To speak to a medical negligence solicitor about kernicterus and hyperbilirubinemia just email our lawyers offices or complete the contact form or call our solicitors helpline. Our solicitors offer advice at no cost and with no further obligation.

Neonatal Hyperbilirubinaemia


In neonatal hyperbilirubinaemia, the total serum bilirubin level is greater than 5 mg/dL. Some degree of jaundice is present in up to 60 percent of newborn infants in the first week of life. Few have much problem with it and the condition is self limited. On the other hand, neonatal hyperbilirubinaemia can become associated with more severe illnesses such as metabolic disorders, endocrine disorders, anatomic problems of the liver, infections and haemolytic disease of the newborn.

The jaundice itself comes from unconjugated bilirubin, which is deposited into the skin and mucus membranes. The result is a yellow or orange colouration to the skin. The bilirubin is unconjugated, meaning that it hasn’t been processed by the liver, usually because the liver is overwhelmed and can’t handle the load of bilirubin.

There are many risk factors for hyperbilirubinaemia of the newborn. These include the following: -

  • ABO or Rh incompatibility between the mother and the fetus
  • Breastfeeding
  • Taking Valium or oxytocin in pregnancy
  • Having gestational diabetes
  • Being of Asian or Native American ethnicity
  • Birth trauma
  • Birth infections
  • Prematurity
  • Family history

The bilirubin comes from haeme degradation. When haeme degrades, it eventually turns into bilirubin, which is insoluble in plasma and needs a binding protein in order to remain in solution. Normally, it is conjugated in the liver and passes through the stools. Babies make about 6-8 mg per kg of bilirubin per day in the neonatal period. This rate rapidly returns to normal adult levels by two weeks of age.

Kernicterus


In kernicterus, unbound lipid-soluble bilirubin is able to cross the blood brain barrier. Sometimes, albumin-bound bilirubin can make it across the blood brain barrier. The exact toxic level of bilirubin in the blood varies from infant to infant so there not just one number that does or does not lead to kernicterus. There should be a significant worry, however, with a bilirubin level above 25 mg/dL. If the infant is suffering from haemolysis, then the concern should be present if the levels reach 20 mg/dL.

Unfortunately, the effects of bilirubin toxicity on the brain are irreversible. The early signs of trouble are quite subtle. They usually start around day 3-4 after birth. If the baby survives the initial insult of bilirubin, there is the gradual development of motor delays, developmental delays, deafness and mild mental retardation. In newborns, one can see lethargy, seizures, irritability, feeding problems, a high pitched cry, low motor tone, hearing loss, apnea difficulties, high motor tone (later) and eventually athetoid cerebral palsy and mild mental retardation.

In the newborn, the physical exam reveals skin and mucus membrane jaundice that starts in the head and works its way down to the feet. If it has reached the soles of the feet, the bilirubin level is likely to be at least 15 mg/dL. If the bilirubin is less than 4 mg/dL, you will likely not notice it. On the other hand, if the jaundice is at the level of the nipples or below, it is increasingly difficult to predict accurately the level of the bilirubin.

The treatment of jaundice in the healthy newborn focuses on promoting fluid intake and using bilirubin lights to bring the bilirubin down. Bilirubin is sensitized to light and is conjugated by its presence. Bilirubin lights can involve lights placed in an isolette or a bilirubin blanket that the baby is draped in for several days until the bilirubin drops to normal levels. If the bilirubin level is toxic and kernicterus is a concern, then exchange transfusions are done to exchange blood with high bilirubin levels with blood that has low bilirubin levels. In cases of hyperbilirubinaemia associated with breastfeeding, the woman can continue breast feeding but should supplement the baby’s intake with fluids to reduce the level of bilirubin in the blood.

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