What is Jaundice?:
Most of us have heard of Jaundice; in newborns it appears as a yellowish complexion. This condition is also called Hyperbilirubinemia or simply put: too much bilirubin. Jaundice in the newborn, caused by an excess of a protein in the blood called bilirubin, is usually harmless, and most of the time it resolves without treatment. However, if the presence of bilirubin climbs to unacceptable levels, there is a chance that, if untreated, the protein can deposit in the brain tissue of a newborn, and may cause irreparable brain damage.
What is Kernicterus?:
When too much of the bilirubin protein deposits in the brain tissue of a newborn, it may result in a type of brain damage called Kernicterus. This particular type of damage is associated with neurological impairment including cerebral palsy (an inability to control muscle movement of the face, body, arms, and legs). It has also been associated with deafness, learning disabilities and other conditions.
Who is at risk?:
All newborn babies are at risk to suffer from Jaundice. Males are more prone to abnormal levels of bilirubin, as are breast fed babies, and those of Asian decent. Premature babies are at greater risk for the bilirubin protein to deposit in the brain tissue, even at lower levels.
How is Jaundice diagnosed and monitored?:
It is a standard within the medical community that all newborns should have their bilirubin levels tested at least once after their birth before they are discharged from the hospital. This is achieved with a simple blood test, and, often picks up slightly abnormal levels in bilirubin. Abnormal test results should alert healthcare providers to closely monitor the baby while still admitted, and, provide proper instructions to parents upon the child’s discharge from the hospital, specifically with regard to the dangers and signs of Jaundice. Discharge instructions should also include follow-up appointment information. For example, the standard of care requires instructions to new parents whose child is released from the hospital in less than 48 hours after birth to see a pediatrician within two days of discharge. In addition, a newborn’s activity and coloring should be carefully observed by healthcare providers in and out of the hospital, as well as by parents and other family members, to see if there is any noticeable yellowing of the skin, or, an increase in this coloration. Typically, this yellowing starts at the top of the head, and as bilirubin levels increase, the complexion may become more severe and extend down the face, neck and trunk. It is critical that parents immediately bring any abnormalities with regard to their newborn’s complexion to the attention of healthcare providers.
How is Jaundice treated?:
If Jaundice is observed in the hospital, it is often treated by simply placing the child under UV (ultraviolet) lights. Once Jaundice is diagnosed, bilirubin levels may be monitored to ensure that they drop. In the hospital repeat blood work is also a simple matter. If the child has already been discharged from the hospital, monitoring is done most accurately by virtue of repeat blood tests within a day or 2 of the newborn’s discharge, or within a day or 2 of the diagnosis. If the protein levels are found to be dropping, then typically no treatment is required. If levels continue to rise, the baby may need to be kept in the hospital or re-admitted for either UV therapy, or if the condition is severe enough, for blood transfusion therapy as well. In cases of mild Jaundice, healthcare providers often recommend that a newborn who is discharged be placed near a window at home, where they are exposed to natural light. This “home remedy” can help babies with slight jaundice to normalize their protein levels as they are exposed to the UV rays contained within natural light. Some doctors recommend that breast feeding be stopped until bilirubin levels normalize.
If diagnosed in a timely manner, Jaundice is easily treatable and, and if so, very rarely results in a child suffering from injury. However, if healthcare providers, including nurses and pediatricians, fail to timely recognize the signs and symptoms of Jaundice, and further, fail to timely perform proper tests and follow-up examinations, this condition may not be diagnosed in time to prevent its effect on the newborn brain (Kernicterus). Likewise, if treatment is delayed or is insufficient to treat the condition, Kernicterus may occur.
Blume Goldfaden has represented numerous neurologically impaired children and their families in cases where there was a failure to properly diagnose and/or timely treat hyperbilirubinemia. If you have any questions about your child, please feel free to call or e-mail, and one of our New Jersey medical malpractice attorneys will be happy to speak with you free of charge.