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Alternative Names Return to topBilirubin encephalopathy
Definition Return to top
Kernicterus is a rare neurological condition that occurs in some newborns with severe jaundice.
See also: Newborn jaundice
Causes Return to top
Kernicterus is caused by very high levels of bilirubin. Bilirubin is a yellow pigment that is created in the body during the normal recycling of old red blood cells. High levels of bilirubin in the body can cause the skin to look yellow (which is called jaundice).
In some cases when there are extremely high levels of bilirubin in the body or the baby is extremely ill, the substance will move out of the blood and collect in the brain tissue. This can lead to serious neurological complications, including brain damage.
Kernicterus usually develops in the first week of life, but may be seen up until the third week. Newborns with Rh hemolytic disease that leads to hydrops fetalis are at high risk for severe jaundice that leads to this condition. However, kernicterus has been seen in apparently healthy babies.
Symptoms Return to top
The symptoms depend on the stage of kernicterus.
Late stage (full neurological syndrome):
Exams and Tests Return to top
A blood test will show a high bilirubin level (greater than 20-25 mg/dL).
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
Treatment Return to top
Treatment depends on how old the baby is (in hours) and whether the baby has any risk factors (such as prematurity).
Outlook (Prognosis) Return to top
Kernicterus represents an extreme condition caused by hemolysis. The outcome is guarded. Many infants with late stage neurological syndrome die.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Seek immediate medical help if your baby has signs of this condition.
Prevention Return to top
Early diagnosis and treatment of jaundice or conditions that lead to jaundice may help prevent this complication. The American Academy of Pediatrics recommends that infants with the first signs of jaundice have their bilirubin level measured within 24 hours. If the level is high, the infant should be screened for diseases that involve the destruction of red blood cells (hemolysis).
The association also recommends that all newborns have a follow-up appointment within 2 to 3 days after leaving the hospital. This is particularly important for premature or near-term babies.
References Return to top
American Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia: Neonatal jaundice and kernicterus. Pediatrics. 2001;108:763.
American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114: 297-316.
In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 102.Update Date: 6/1/2009 Updated by: Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.