Pediatrics

Kernicterus in the baby

definition

Baby kernicterus is a serious complication of neonatal icterus that causes damage to brain structures. Newborn jaundice is a yellow discoloration of the skin, mucous membrane or internal organs of the newborn that occurs after birth. It can also occur physiologically for a certain period of time, i.e. without any disease value. It is triggered by increased bilirubin levels in the blood (Hyperbilirubinemia).

In the special form of newborn jaundice, jaundice prolongatus, this persists for more than two weeks.

Symptoms of kerinicterus

Symptoms accompanying the onset of kernicterus in the baby are one apathy of the child, i.e. a certain indifference of the child to what is happening. Decreased neonatal reflexes, such as Grasping reflex, Moro reflex, swallowing reflex and sucking reflex can also occur. Another symptom is that Opisthotonus. This means a strong spasm of the back and neck muscles, which leads to a back curve and "bridges".

Additional symptoms are high-pitched screaming, reluctance to drink and the sunset phenomenon on the eye. The sunset phenomenon describes the disappearance of the cornea of the eye behind the lower eyelid. So with the open eye is the white one Sclera clearly visible above. At first glance, you might think the child is looking down. This is normal in the early stages of development of the newborn as the coordination of the eye muscles is not fully developed. However, it should no longer occur after the first few weeks of life and can then be an indication of an illness.

If no therapy is carried out, the long-term effects can be even more serious.

also read: Kernicterus

causes

Another term for kernicterus is Bilirubin encephalopathy.

The trigger of kernicterus is this Hyperbilirubinemia, meaning too high bilirubin levels in the baby's blood. Bilirubin is a breakdown product of hemoglobin found in red blood cells. It is yellow-brown, which explains the yellowing of the skin.

Causes for an increase in bilirubin are:

low food intake,
Breast milk,
Medication,
Infections,
Hematomas
and other reasons

which lead to a breakdown of red blood cells etc.
Premature babies are also more likely to suffer from it.

If therapy does not take place or it is started too late, the Hyperbilirubinemia lead to kernicterus. Here, the bilirubin gets into structures of the brain and inhibits biochemical processes in the cells, which leads to the death of these cells, which can have serious consequences.
The so-called basal ganglia, which are a group of brain nuclei, are particularly affected by cell death. Hence the name kernikterus.

Read more on the topic: Blood group intolerance

diagnosis

The first indication of increased bilirubin values and thus also of kernicterus is provided by the conspicuously yellow skin color of the newborn. There follows one transcutaneous Bilirubin determination, whereby the yellow color of the skin is measured with light signals. If increased values are detected, the bilirubin is precisely determined by taking a blood sample. Other blood values are also determined, such as Liver enzymes or infection parameters to rule out other causes.

The kernicterus itself is only noticeable through the baby's symptoms, which are triggered by damage to brain structures.

therapy

There are various therapy options that depend on the level of bilirubin in the baby's blood. Phototherapy is carried out if the indirect bilirubin is above 15 mg / dl. The baby's skin is irradiated with blue light with a certain wavelength. This converts the water-insoluble indirect bilirubin into a water-soluble form and can therefore be excreted in the bile or urine.

If bilirubin values are above 25 mg / dl, or if the phototherapy does not show the desired effect, a blood exchange transfusion is used. Here, all of the newborn's blood is exchanged with donated blood. Strict attention must be paid to compatible blood groups between donor and recipient. The exchange of the entire blood does not take place at once, but in 5-20 ml portions via a catheter in the baby's umbilical vein. Side effects of this method can include infections, a drop in blood pressure, thromboses or immune reactions to the donor blood.

Read more on the topic: Blood exchange transfusion

forecast

The prognosis for neonatal icterus without kernicterus is good and there are usually no sequelae. However, if the high bilirubin values lead to kernicterus, severe and irreversible long-term effects can occur. If there is no therapy, deafness, cerebral seizures and psychomotor retardation (e.g. movement disorders) can occur.

Another late consequence is that Cerebral palsy that accompanies