“Kernicterus” is a funny-sounding word that most people don’t know until a doctor says it to them. But if a doctor has told you that your newborn child has kernicterus, you know it’s not funny at all. What is kernicterus?
Simply put, kernicterus is a preventable type of brain damage found in newborn infants. It is caused by very high bilirubin levels, or hyperbilirubinemia, in medical terms. Bilirubin comes from the breakdown of red blood cells, which die (and are created) on a regular basis. During pregnancy, the baby’s bilirubin is removed by the mother’s liver. After birth, the baby’s own liver must take over and break down the bilirubin so it can be removed from the body. In the newborn stage, the rate of red blood cell breakdown is high. If the baby’s liver is not developed enough, it can struggle to keep up, leading to a buildup of bilirubin.
It is usually easy to tell if a baby has somewhat elevated bilirubin levels, because bilirubin is yellowish in color; this is what causes jaundice, a yellowing of the skin and whites of the eyes. Jaundice is extremely common in newborns—more than half of all babies have it. It usually causes no problems and resolves on its own, without treatment, in a few days. More stubborn jaundice may require a baby to be placed under special lights (phototherapy) in the hospital or in some cases, at home. Even in these cases, the baby usually suffers no long-term ill effects.
Some forms of jaundice are more severe, typically featuring extremely high bilirubin levels. This can cause bilirubin to cross into the brain, which results in brain damage. This is kernicterus. It is devastating, all the more so for being preventable.
Elevated bilirubin levels can, and should, be detected through the monitoring of bilirubin in newborn infants. This can be done by drawing blood, usually from the baby’s heel, and performing lab tests for bilirubin. The result of this test is a total serum bilirubin level (TSB) A doctor or nurse may also place a light meter on the baby’s head, which gives a transcutaneous bilirubin (TcB) level. If a TcB is the first test performed, and levels are high, a blood test for TSB should be ordered next.
If bilirubin levels are elevated, there are a number of treatment options. Phototherapy may be used. Fiber optic blankets and blood exchange tranfusions are other options. The bottom line is that elevated bilirubin should be caught and addressed before it leads to brain damage.
Doctors are humans, and humans make mistakes. However, when the cost of the mistake is so high, and the opportunity to prevent it is readily available, mistakes leading to kernicterus often constitute medical malpractice.
Some mistakes doctors make include not taking into account an infant’s exact age when evaluating bilirubin levels. A bilirubin level that would be normal at one hourly age might be dangerously abnormal at another. Delay in action is another frequent mistake. Rather than immediately beginning treatment when high bilirubin levels are detected or suspected, a physician might order repeat testing, allowing bilirubin to build up further. A doctor might also delay treatment to perform other diagnostic tests.
Delayed diagnosis may also occur because of misread test results. TSB is the sum of indirect bilirubin and direct bilirubin. If a doctor reads the indirect bilirubin result as TSB, he or she might wrongly conclude that a child’s levels are lower than they are in fact. And, of course, a doctor could simply miss the signs of acute kernicterus during an examination. These signs can include shrill, high-pitched crying; drowsiness or low energy; fever; stiffness or floppiness of the whole body; low muscle tone; poor feeding; and unusual eye movements. A child may not have all of these signs of kernicterus, and many of these signs could signal different ailments, but a reasonable doctor should still be on the lookout for kernicterus when confronted with them.
With many medical conditions, it can be difficult to discern whether they were avoidable or caused by medical malpractice. With kernicterus, the answer is much clearer. Kernicterus is a preventable birth injury, and failure to prevent it is almost always the fault of the medical professionals involved in a newborn’s early care.
Kernicterus may also result in lifelong deficits for your child, leading to expenses for therapy and care, and perhaps lost wages for a parent who must now stay home to be present for your child. You should not be forced to bear this financial burden without compensation from the parties responsible. You have only a limited amount of time to file a claim for medical malpractice. After that time passes, you will not be able to file a claim, no matter how great your child’s need. We invite you to contact The Fraser Law Firm P.C. and schedule a consultation with our experienced Oregon medical malpractice attorneys.
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