NO BABY SHOULD DEVELOP BRAIN DAMAGE FROM UNTREATED JAUNDICE. We strongly advocate screening that looks like this.
TEST.
T – Test Blood – The most accurate way to measure bilirubin is with a small blood sample from the baby’s heel. This results in a total serum bilirubin (TSB) level.
E – Evaluate Bilirubin Nomogram – Once you have the TSB level, evaluate it using the bilirubin nomogram chart or bilitool.org. Findings are based on the baby’s age in hours and the TSB level.
S – Screen Risk Factors – Common risk factors that must be considered are:
- PREMATURE BIRTH
- EAST ASIAN OR MEDITERRANEAN ETHNICITY
- BABIES WITH DARKER SKIN
- SIBLING WHO HAD JAUNDICE
- FEEDING DIFFICULTIES
- BREAST-FEEDING
- BRUISING
- BLOOD GROUP INCOMPATIBILITY (RH OR ABO PROBLEMS)
T – Treat – The severity of the newborn’s jaundice will determine if and what type of treatment is needed:
- MILD: IF THE BABY HAS MILD LEVELS OF JAUNDICE, IT USUALLY GOES AWAY ON ITS OWN. PLENTY OF FLUIDS OF FREQUENT FEEDINGS CAN HELP MAKE THE JAUNDICE GO AWAY.
- MODERATE: IF THE BABY HAS MODERATE LEVELS OF JAUNDICE, A DOCTOR MAY RECOMMEND PHOTOTHERAPY. DURING PHOTOTHERAPY, THE BABY IS PLACED UNDER PHOTOTHERAPY LIGHTS. THE LIGHT HELPS THE LIVER REMOVE BILIRUBIN IN THE BABY’S BODY. THE BILIRUBIN SHOULD BE TESTED AGAIN EVERY 24 HOURS TO ENSURE KERNICTERUS DOES NOT OCCUR.
- SEVERE: IF THE BABY HAS VERY SEVERE JAUNDICE, A DOCTOR SHOULD IMMEDIATELY RECOMMEND AN DOUBLE VOLUME EXCHANGE TRANSFUSION. IN THIS TREATMENT, THE BABY’S BLOOD IS EXCHANGED WITH DONATED BLOOD TO IMMEDIATELY REMOVE THE BILIRUBIN FROM THE BLOOD TO STOP OR PREVENT BRAIN DAMAGE
Basic Info on Jaundice
Jaundice will appear first on the face and then move to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also turn yellow. Jaundice can be harder to see in babies with darker skin color. The baby’s doctor or nurse must test to see how much bilirubin is in the baby’s blood. NEVER rely on a visual assessment to determine whether your child is at risk. This is often how kernicterus occurs.
The following signs or symptoms may indicate severe jaundice or complications from jaundice. Call your doctor and insist on a blood test if:
- YOUR BABY’S SKIN BECOMES MORE YELLOW
- YOUR BABY’S SKIN LOOKS YELLOW ON THE ABDOMEN, ARMS OR LEGS
- THE WHITES OF YOUR BABY’S EYES LOOK YELLOW
- YOUR BABY SEEMS LISTLESS, SICK OR DIFFICULT TO WAKE
- YOUR BABY ISN’T GAINING WEIGHT OR IS FEEDING POORLY
- YOUR BABY MAKES HIGH-PITCHED CRIES
- YOUR BABY DEVELOPS ANY OTHER SIGNS OR SYMPTOMS THAT CONCERN YOU
- DIAGNOSED JAUNDICE LASTS MORE THAN THREE WEEKS
Get emergency medical help if your baby:
- IS CRYING INCONSOLABLY OR WITH A HIGH PITCH.
- IS ARCHED LIKE A BOW (THE HEAD OR NECK AND HEELS ARE BENT BACKWARD AND THE BODY FORWARD).
- HAS A STIFF, LIMP, OR FLOPPY BODY.
- HAS STRANGE EYE MOVEMENTS OR EYES ROLLED INTO THE HEAD.
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Great info… great website! I have been doing research on the kernicterus and jaundice and I was appalled when the study’s summary stated that because kernicterus was so rare, that to test every child was not cost effective! I work for an organization called g6pddeficiency.org and we are pushing to get babies tested for jaundice AND g6pd deficiency…as the more serious bouts with jaundice happen to babies that inherit this genetic disorder. I would definitely g6pd deficiency (a genetic disorder) to your list of risk factors for infants. This genetic disorder is more common in people of Asian, Mediterranean, or African descent, so that is why those babies with those ethnic characteristics are at a higher risk for jaundice.
MY SON HAS SEVERE KERNICTERUS AND G6PDD. I am also pushing for change here in the UK meeting with the government soon wish me luck 🙂
Michael Kalisperas
http://www.mylittlespartan.com
There needs to be more information given by hospitals about jaundice – on taking our premie home the pediatrician told us she has jaundice it’s very common just make sure her eyes don’t get yellow. I breastfeed and she wasn’t getting adequate nutrition because she wasn’t sucking effectively – she arched her back several times / no one caught it at her newborn visit it wasn’t until her two week visit they recognized a problem and had us supplement. I don’t know if she has any brain damage but it hurts me to see how this can happen and how a hospital will give you twenty pamphlets on “breast is best” but not even mention to new parents that jaundice can cause brain damage. There needs to be A LOT more education – no one would purposefully let this happen to their children but who would know when the doctors tell you that jaundice is so common and nothing to worry about… How about a pamphlet with all the warning signs?!
Yes Jennifer! We completely agree. picK partnered with the CDC to create some very informative materials. Many of our families have worked to get the CDC’s pamphlets on jaundice distributed in the hospitals where our children were born and others. If you’d like to do the same, the link is here: http://www.cdc.gov/ncbddd/jaundice/freematerials.html
Hi, i am from India. My son had total serum bilirubin level of 10mg/dl at age 22 hours (ABO incompatibility). He is a full term healthy child, weighing 3.83kg at birth. After a few hours, doctors advised us for phototherapy but due to some unavoidable circumstances, Phototherapy was started at around 58 hours of age. At that point TSB was measured at 13.5mg/dl. It remained at 13.5 in next reading despite continuous phototherapy and then gradually decreased to normal levels. Is there anything to worry. Can a peak level of 13.5mg/dl cause brain damage. This thought scares me…did we wasted too much precious time.
Hi there,
It sounds like your son might be very fortunate! We cannot offer medical advice, as we are simply living with the condition ourselves but it seems that it would be unusual for a healthy full term infant to develop kernicterus form a bilirubin of 13.5.
My 16-month-old daughter has had Crigler Najjar syndrome since she was born, that is, she still does 13 hours of phototherapy to keep her bilirubin value constant at 12. When she was 1 month old, not knowing that she had this syndrome, her bilirubin had reached at 34 resulting in kernicterus. Because of this she suffered damage to her brain causing her Mobility difficulties, hypotonia and dystonia. She is going to have a liver transplant so that there is no risk of her bilirubin rising so high that her life is in danger. I wish I knew from the beginning how dangerous jaundice can be so that I could move differently but unfortunately in Greece they also treat jaundice as something harmless that just yellows the skin.
Very sorry to hear this Katerina! Our kids suffer so much from that critical medical ignorance. If you haven’t already, please join us at http://www.facebook.com/groups/Kernicterus
-miriam