What is kernicterus

The appearance of jaundice of the skin in a newly born child is not something exceptional. This symptom manifests itself in almost every second baby. As a rule, in this case, doctors diagnose physiological jaundice, which does not require medication and eventually goes away on its own. But there are cases when, due to too high a content of bilirubin in the blood, pigmentation begins to affect brain cells. This is kernicterus of newborns.

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Causes of appearance

The causes of jaundice are not so numerous and are associated with a lack of enzymes that deliver bilirubin to the liver. First of all, premature babies fall into the risk group, since it is their body that is not yet adapted to independent life. Children, on the head and skin of which there are massive hemorrhages, are also at risk of getting sick. If a woman has several children and at least one had severe jaundice, during the subsequent pregnancy, you need to be especially careful because of the possible development of kernicterus in the infant. Other causes of the manifestation of the disease can be as follows:

  • Rh-conflict between mother and fetus,
  • hematomas, trauma and other injuries sustained by an infant during childbirth,
  • genetic tendency to this type of disease,
  • fetal hypoxia or oxygen starvation,

Symptomatology of the disease

At the initial stages of the development of nuclear jaundice in newborns, the following symptoms are observed:

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  • yellowness of the skin,
  • refusal of breast and artificial feeding,
  • weakness, drowsiness,
  • an increase in body temperature.

Such children begin to suffer from arterial hypotension, often throw back their heads and bend their whole body, while rolling their eyes. When performing an ultrasound scan, doctors reveal that they have an enlarged spleen and liver.

At the last stage of the disease, newborns emit loud monotonous measured screams, straining the occipital muscles. Other symptoms are also characteristic:

  • seizures, apnea and sometimes vomiting
  • the child’s eyes roll
  • breathing is disturbed.

A child who has suffered from nuclear jaundice may have complications – impaired hearing, tooth enamel, intellectual development, paralysis.

The disease develops quite intensively – in just 7 days. Therefore, if you see the slightest signs of its manifestation, immediately inform your doctor about them. After all, timely determination and diagnosis will be extremely important in order to exclude further negative consequences for the baby’s health.

An infant who has not received timely treatment has a manifold increase in the likelihood of brain damage. Such children are lethargic, weakened, do not show any reaction to external stimuli, including the voices of their parents.

Diagnostic problems

Due to the fact that the primary symptoms of kernicterus are very similar to physiological jaundice, there are problems with its diagnosis. And the reasons for throwing the head back and increased muscle tone may indicate brain disorders of any other nature. Therefore, the correct diagnosis must be started with taking a blood test for bilirubin. To eliminate any inaccuracies, it is recommended to conduct repeated analyzes, this is also necessary in order to see the dynamics of indicators. The level of bilirubin changes with each day of the baby’s life. For example, in 1 day it reaches up to 34 μmol/l. On the second day, this indicator should not exceed 149 μmol/L, and from 3 to 5 days – 205 μmol/L. After the first weeks in a child, as in an adult, this figure is approximately 20 μmol/l.

Along with this, a number of laboratory tests are carried out:

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  • liver function tests,
  • UAC (complete blood count),
  • OAM (general urine analysis),
  • the blood group of the child and his mother is established,
  • anti-globulin test or Coombs’ test,
  • a blood clotting test or PTI,
  • analysis for hormones such as total triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH),
  • ELISA (enzyme-linked immunosorbent assay),
  • PCR (polymerase chain reaction).

In addition to laboratory tests, tomography or MRI can be prescribed, which allow you to get more detailed information about the state of internal organs and the degree of their damage than standard ultrasound.

The symptoms of kernicterus in the early stages are similar to the hepatitis virus. In order to eliminate the risk of developing the last disease, the patient may be prescribed a series of tests. The virus can be detected thanks to antibodies to the antigen of the hepatitis virus.

  • Hepatitis A is detected due to the level of anti-HAV IgG and anti-HAV IgM antibodies.
  • Taking a blood test for anti HBcor is the most effective way to determine the hepatitis B virus in the body due to the fact that anti-HBcor is produced in response to the anti-HBcAg virus contained in the very epicenter, the nucleus of the virus.

You may also need to take a test for antibodies to nuclear antigen.

Treatment methods

As a rule, doctors use different methods of therapy in combination, which only increases the positive effect and quickly relieves all harmful symptoms. Kernicterus is treated as follows:

  • phototherapy,
  • medications,
  • using glucose.

In especially severe cases, blood or plasma transfusion is prescribed.

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The most qualitative and effective method of combating jaundice is the so-called lamp method or phototherapy. A child stripped to the waist is placed in a special box, where his eyes are covered and he is under the direct influence of special rays. This radiation contributes to the elimination of excess bilirubin from the baby’s body physiologically, in other words, with urine and feces. The safety of this treatment does not mean that it can be performed without specialist supervision. The consequences of such self-medication can be very sad and lead to dehydration or heat stroke.

In addition to this method, infusion treatment may be prescribed. Its essence lies in the introduction into the child’s body of a solution consisting of glucose and saline solution. This additional effect contributes to the early elimination of the toxin from the body. To improve the functioning of the liver and for the purpose of energy reinforcement, babies are given a 5% glucose solution to drink.

A less innocuous method of fighting disease is the use of drugs. Until now, Phenobarbital has been actively used. Thanks to the development of the pharmaceutical industry, it was replaced by Zixorin. In addition, patients are prescribed diuretics, as well as drugs that significantly increase the lifespan of liver cells. Naturally, all these medications can harm a small, not yet matured body and manifest as side effects. But in any case, the consequences of taking them seem insignificant in comparison with the benefits they provide.

Since kernicterus is characterized by damage to the brain tissue, and the total effects of photo and drug therapy are insignificant, doctors prescribe an exchange transfusion of blood or its plasma. With the help of a catheter, which is inserted into the umbilical vein, some blood is taken from the baby, cleansed and given back. The entire procedure is carried out under the supervision of the attending physician.

Prognosis and prevention

Since this disease is characterized by damage to brain cells, after its treatment, the child may show signs of complications – problems with vision and hearing, as well as problems with the development of tooth enamel. And this is not a complete list, the consequences of the influence of bilirubin on the brain can be more detrimental. Subsequently, the baby may have symptoms of disorders of the musculoskeletal system.

To avoid such serious disturbances in the work of the body, prevention should be followed. An infant at high risk of developing jaundice should be kept under medical supervision. If the first signs of the development of the disease are noticed, the specialist will instantly be able to provide qualified assistance.

The doctor must closely monitor the level of bilirubin in the blood, for which an hourly blood sample is taken.

For the early removal of bilirubin from the baby’s body, he should receive as much nutrition as possible, breast milk. Colostrum production is especially important. After all, the more a child eats, the more he defecates and urinates.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.