What is Kernicterus?
Kernicterus is an extremely uncommon bilirubin - induced brain damage , which occurs in newborns suffering from severejaundice . Kernicterus go on when there is accumulation or hike of haematoidin layer in the roue . This then propagate to the tissue paper of the mental capacity . Depending on the spread of the bilirubin to the brain , the patient can have balmy to permanent nous damage and in some cases even dying . Prevention of Kernicterus can be achieved by treat jaundice as presently as it gets discover and before it acquire severe .
Signs & Symptoms of Kernicterus
Certain symptoms indicate that the baby has Kernicterus :
The potential lasting harm result from kernicterus can also get long - term :
Classification of Kernicterus
Acute Bilirubin Encephalopathy ( ABE):This is an piercing condition where there is an increment of haematoidin in the primal nervous organization . The baby has wide range of symptoms such as diminish feeding , lethargy , high - cant over cry , hypertonia or hypotonicity , spasmodic torticollis , opisthotonus , sunset optic star sign , seizures , fever , and even demise . The bilirubin needs to be reduced rapidly , if not then Acute Bilirubin Encephalopathy progresses to Chronic Bilirubin Encephalopathy .
Chronic Bilirubin Encephalopathy ( CBE):This is a continuing state where the baby has knockout neurologic lesions induced by bilirubin . Decrease in the bilirubin in this stage will not overturn the consequences . The symptom in this stage includemovement disorderssuch asdystoniaor athetoid cerebral palsy ; auditive dysfunction , such as auditive neuropathy , oculomotor impairments ( strabismus , nystagmus , spoil downward / up gaze , cortical ocular stultification ) , dysplasia of the deciduous teeth / dental enamel hypoplasia , impaired digestive single-valued function and gastroesophageal reflux . lesion in the basal ganglia , nervus oculomotorius nuclei of the brain stem and auditory nuclei of the brain stem termination in the above mentioned impairments .
Subtle Bilirubin Encephalopathy ( SBE):This is a inveterate state of neurologic disfunction which is induced by mild increment in the hematoidin storey . This may result in movement , learning and neurologic disorder , auditory dysfunction and isolated audience loss .
Causes of Kernicterus
The cause of Kernicterus is increased levels of bilirubin in the blood of the newborn baby . If this is not treated instantly , then the conglomerate bilirubin spreads to the learning ability and causes long - term equipment casualty . If the buildup of hematoidin is less , then it is termed as mild jaundice , which lends a somewhat yellowish tint to the skin and sometimes eye of the newborn babe . In normal cases , the liver and kidney eliminate the extra bilirubin from the bloodstream , which leaves the consistency through urine and stool . In maternity , the female parent ’s consistency will take away the excess hematoidin for the baby . Emily Post bringing , it takes some day for the liver of the new-sprung baby to get adjusted at removing the bilirubin from the blood . If the sister is fed every couple of hours , then the mild jaundice commonly goes away on its own after some daylight . However , if the signs of the jaundice still hang on and step-up , then the babe needs immediate aesculapian attention .
If there is exacerbate of the jaundice and treatment is not started , then the bilirubin gather and reaches a mellow level in the blood and this is when kernicterus becomes a serious matter . Some babies may have some health problems , which makes them more prone to have increase levels of bilirubin such as in hemolytic disease , where the female parent ’s Rh blood factor is not compatible with the baby ’s and this results in increased product of bilirubin in the babe . Intestinal occlusion in the baby can also make it difficult to remove the bilirubin .
Other factors which increase the chance of the child modernize kernicterus include : previous birth , polycythemia , sulfonamides , Gilbert ’s syndrome , Crigler - Najjar syndrome type-1 , G6PD lack , trouble with breastfeeding , jaundice within the first 24 hours of birth , haemorrhage or bruises on the baby ’s head due to a hard birth and if the baby has an older sibling who has obtain phototherapy for acrimony .
Diagnosis of Kernicterus
Medical history and forcible exam of the baby is done for diagnosing of kernicterus . roue tests assist in confirming the diagnosis by valuate the haematoidin layer in the baby ’s blood . Once the kernicterus has started to develop in the babe , then it means that brainiac damage has already occurred . So , it is important to treat bitterness as shortly as potential before there is a dramatic increase in the bilirubin levels .
Prevention of Kernicterus
Prevention of Kernicterus can be achieved by knowing the symptoms of jaundice in the newborn babies . Kernicterus can also be prevented by have the baby tested on time and lead off early discourse . A transcutaneous haematoidin exam is done , if the baby show up signs of jaundice and is still in the hospital , in which a pocket-sized gadget is mildly placed against the child ’s skin for checking the hematoidin levels . A line of descent trial can also be done to check the bilirubin stage of the baby . Phototherapy or light therapy is started as discussion for a baby with an increased bilirubin degree . For very mild cases , discourse can be done at rest home using lights given by the hospital . Treatment of acrimony with phototherapy in newborn is nothing to panic about , as it does not mean that the child will have brain damage . Phototherapy is done to foreclose the hematoidin from increase to a grievous level .
It is of import to course the baby every 2 to 3 hour . This will help in passing the haematoidin out of the body through throne and urine . Before getting discharged from the infirmary it is of import to get a well - babe cheque - up done . Jaundice in newborn in often at its worst at day 5 , therefore it is important to confab the pediatrician within the first 5 day of the child ’s nascency .
aesculapian attending should be sought instantly if there is worsening of the icterus and if the pelt on the babe ’s arms , corporation or legs begin getting white-livered . The whites of the babe ’s eyes should also be checked for yellow . quick medical help should be seek if the infant is looking jaundice , is sleeping a lot , not fertilise , is difficult to wake or becomes very fussy .
Treatment of Kernicterus
As of now , there is no effective treatment for all revoke the damage of kernicterus . prompt treatment for Kernicterus help oneself in preventing the decline in quality of the brain hurt . Treatment for Kernicterus begin with phototherapy . endovenous fluid are pay to maintain adequate hydration . The baby may also ask tube feeding where a subway system is come in down the throat of the baby , which top into the breadbasket . Blood test to determine the bilirubin levels are done and also to find out the baby ’s blood group in case the child needs an emergent stemma blood transfusion . Blood transfusion help in eliminating the supererogatory bilirubin from the baby ’s blood .
Long - terminus intervention for kernicterus and the resulting brain damage depends on the type of harm and the impairments the child has . handling for Kernicterus consists of voice communication therapy , physical therapy and special training . Some patients have had some welfare from recondite brain stimulant . medicine such as clonazepam , baclofen and artane can be prescribe for managing movement disorders , as a result of kernicterus . pick up aids and cochlear implants also have known to improve the listening loss , which occurs with kernicterus . Proton pump inhibitors can be dictate for acid ebb .
