Kernicterus: Signs, Diagnostics, and Remedies
In industrialized countries, the incidence of kernicterus or acute bilirubin encephalopathy in newborns is remarkably low, affecting between 0.4 and 2.7 of every 100,000 children. This rare but potentially devastating condition can lead to permanent health complications, making it crucial to understand its causes, symptoms, and treatments.
Kernicterus, caused by excessively high levels of bilirubin in the bloodstream, can result in hearing loss, vision problems, movement disorders, intellectual and developmental disabilities, autistic spectrum disorder, epilepsy, inattention and hyperexcitability disorders, and stained baby teeth. Once kernicterus has occurred, the resulting problems are usually permanent, though some may lessen or go away with therapy, medication, or in adulthood.
Risk factors for kernicterus include mother and child not sharing a blood group, lack of glucose-6-phosphate dehydrogenase, low birth weight, premature birth, sepsis, meningitis, dark skin color, feeding trouble or poor appetite, bruising or bruising conditions, family history of jaundice, bruising or injuries from a difficult birth. Newborns are diagnosed with jaundice when they have bilirubin blood levels greater than 85 micromoles per liter (μmol/L) or 5 milligrams per deciliter (mg/dl).
In newborns, jaundice is often initially tested by placing a light meter on the forehead to get a transcutaneous bilirubin (TcB) level reading. Routine TcB level tests are done every 8 to 12 hours in the first 48 hours of life, and at least once more at 3 to 5 days old. If the TcB level is high, a blood test is done to get a reading for the total serum bilirubin (TSB) level.
Common causes of significant jaundice include underdeveloped, diseased, or damaged liver, destruction of red blood cells, premature birth, increased bilirubin production, Gilbert's syndrome, bile duct obstruction or blockage. The body produces bilirubin when old red blood cells are broken down. Bilirubin is typically excreted from the body through the liver, bile salts, intestinal bacteria, feces, or urine. However, in newborns, the organs may not be developed enough to process bilirubin, which can result in jaundice.
The treatment options for kernicterus in newborns focus primarily on reducing elevated bilirubin levels before brain damage occurs. Key treatments include phototherapy (Light Therapy), exchange transfusion, Intravenous Immunoglobulin (IVIG) for blood incompatibility cases, and supportive care, with more advanced or combination approaches used based on severity.
Phototherapy, the most common and first-line treatment, involves placing the baby under special blue lights that break down excess bilirubin in the skin, allowing it to be excreted via urine and stool. Exchange transfusion, used when bilirubin levels are dangerously high and do not sufficiently respond to phototherapy, involves gradually removing and replacing the baby’s blood with donor blood to rapidly reduce bilirubin levels and prevent or limit brain injury. This procedure is done in a neonatal intensive care unit (NICU) under close monitoring.
IVIG is administered intravenously when jaundice results from blood type incompatibility between mother and baby (e.g., Rh or ABO incompatibility). It slows the breakdown of the baby's red blood cells, potentially avoiding the need for exchange transfusion. Fiber-Optic (Bili Blanket) Therapy, a form of phototherapy using a flexible pad that emits therapeutic light, can be used at home for mild to moderate jaundice cases, offering more flexibility than traditional phototherapy.
Pharmacological Approaches, such as Phenobarbitone, have been studied as a safe and effective drug to lower bilirubin levels, although phototherapy remains the primary method. Use of such drugs is less common and typically adjunctive.
Supportive care, including maintaining proper hydration to aid bilirubin excretion and close monitoring of bilirubin levels and jaundice signs, is essential. Educating parents about jaundice signs is important to ensure timely treatment continuation or intervention if needed.
It is crucial to seek immediate medical attention if the symptoms of jaundice or kernicterus occur, as it can take less than 24 hours for serious cases of jaundice to progress to kernicterus. Common symptoms of severe jaundice and kernicterus include stiff, limp, or floppy body, high-pitched, continual crying, strange or uncoordinated eye movements, body arching, seizures, and bulging of the soft spot on a baby's head.
New technologies, such as the BiliScan mobile phone app, are being developed to help parents and caregivers detect jaundice in newborns earlier. Treatment for jaundice depends on the baby's age and bilirubin levels, and may include placing the baby in an incubator under special lights, more frequent feedings, hydration fluids, and blood transfusions for severe cases.
Cases of kernicterus involving adults are considered very rare. High blood levels of bilirubin, beyond the newborn stage, are often a sign of disease or damage to the liver.
In conclusion, understanding the causes, symptoms, and treatments of kernicterus is essential for ensuring the health and well-being of newborns. By recognising the signs of jaundice early and seeking prompt medical attention, parents can help prevent the development of kernicterus and ensure their child's best possible start in life.
- In industrialized countries, proper management of medical-conditions like kernicterus, a rare neurological disorder caused by chronic high levels of bilirubin in newborns, is vital to prevent permanent health complications.
- Science and medical research have revealed that risk factors for kernicterus include factors such as mother and child blood group incompatibility, low birth weight, premature birth, sepsis, meningitis, skin color, feeding trouble, bruising or bleeding conditions, family history of jaundice, and certain chronic diseases like dark skin color and certain genetic disorders.
- Kernicterus can lead to hearing loss, vision problems, intellectual and developmental disabilities, movement disorders, autistic spectrum disorder, epilepsy, inattention and hyperexcitability disorders, stained baby teeth, and other mental-health effects. To prevent these complications, health-and-wellness care for newborns should focus on monitoring and treating jaundice promptly.
- Newborns may require skin-care practices like phototherapy and fiber-optic light therapy to reduce bilirubin levels, and in severe cases, may require exchange transfusions to replace affected blood with donor blood. Nutrition also plays an important role in managing jaundice, as lack of proper nutrition may contribute to bilirubin production.
- Adequate CBD oil usage, when recommended by healthcare providers, may help manage certain chronic diseases, reduce inflammation, and improve liver health in adults, potentially preventing high levels of bilirubin in the bloodstream. It's important to consult healthcare professionals regarding safe CBD usage, especially when considering its applications in managing rare disorders like kernicterus in adults.
