Kernicterus

Kernicterus
by Tracy K. Lischer, Esq.

Doctors, parents, and lawyers need to be alerted to the re-emergence of a preventable medical disorder that is once again affecting children. The disorder is called kernicterus, and it arises when yellow jaundice is not diagnosed and treated appropriately. The hallmark of kernicterus is cerebral palsy. Now that new mothers and their babies are discharged at 48 hours or less, before jaundice has peaked, cerebral palsy from this cause is on the rise. Before aggressive early discharge, this disorder had been virtually eradicated. For younger pediatricians, seeing a patient with full-blown diagnosed kernicterus is like seeing a patient with polio; they never thought it would happen.

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) has issued an ALERT to refocus its members on preventing this disorder. The diagnosis is easily made from a heel prick that measures the level of bilirubin in a baby's blood. There is a new non-invasive test as well. The treatment is phototherapy. If the bilirubin levels are too high (over 18, 20, or 25), depending on the baby's gestational age when born, weight and weight loss, ability to feed, and so on, a blood exchange may need to be performed in a hospital with that capability. In a premature baby or a sick baby, the threshold levels of concern about bilirubin levels are much lower.

Parents of Infants and Children with Kernicterus (PICK) is the new activist parent organization. The parents' stories of giving birth to premature or term babies whose bilirubin levels were ignored until the brain damage was done are compelling and heartrending. Like so much of medical negligence involving newborns, it more frequently happens to first-time parents.

Kernicterus is not diagnosed until around 18 months when athetotic cerebral palsy, hearing loss, and loss of upward gaze can be paired with specific MRI findings and a history of severe jaundice. These children have normal intelligence. They learn to sign and to use augmentative communication devices. They have normal life expectancies. Their Life Care Plans project costs of many millions of dollars for therapies and equipment.

While most cerebral palsy may not be caused by medical negligence, attorneys and parents need to know that kernicterus, particularly in a term, otherwise health baby, is preventable. These cases should result in lawsuits. Where they do, the value of the injuries is so high that it shouldn't take many to reform the system and stop this recurrence.

© 2001, Tracy K. Lisher, Esq. Reprinted with permission.

Tracy K. Lisher, Esq. is a partner in the law firm of Pulley, Watson, King & Lischer.