Kernicterus is what physicians refer to as a "never event". A never event is something that should never occur with good medical care. As such, with very few exceptions, kernicterus almost always means that medical malpractice occurred and caused the baby's injuries. Below is a brief discussion of what kernicterus is and how it causes brain injuries.
Bilirubin is created when red blood cells, which have a lifespan of approximately 45-50 days in newborns, die. Red blood cells can die sooner than 45-50 days old as a result of trauma, certain blood diseases, and a number of other causes. When red blood cells die, the body’s normal physiologic processes break them down and eliminate the resulting by-products. Bilirubin is one of the ‘waste products’ created by the breakdown of red blood cells. Bilirubin has a yellow pigment, and is eliminated from the body in urine, stool, bile, and other secretions. Bilirubin is what lends a yellow/brown hue to normal urine, bile, and stool. When the newborn's body is unable to eliminate bilirubin quickly or efficiently enough to keep the levels low, bilirubin can accumulate in the baby's blood. When bilirubin accumulates in the blood, it causes jaundice, a yellowing of the whites of the eyes, skin, mucous membranes and secretions. High levels of bilirubin can be dangerous to the developing brain of a newborn.
When levels get too high, bilirubin can cross the blood-brain barrier and cause damage to the baby's brain. The resulting injury is called kernicterus. Kernicterus is a signature injury, which actually causes a yellow staining of the brain itself, and results in a specific type of cerebral palsy.
Kernicterus is referred to in medical and legal parlance as a "never event" because it is always preventable, and should never occur in the setting of competent medical care. Treatment is easy and poses very little risk for the baby--usually involving only the use of special lights (phototherapy) that help the baby eliminate bilirubin from his or her body.
Nevertheless, there are still cases of kernicterus in the United States because physicians continue to make common mistakes that can lead to this terrible injury. Some of the common and avoidable mistakes that can cause kernicterus include:
Ø Doctors failing to screen and monitor babies to ensure that blood concentrations of bilirubin do not reach dangerous levels. Prevention is the best medicine here. Remember, kernicterus is always preventable. It is easy to obtain a blood level of bilirubin, and this should be done repeatedly so that the levels can be compared over time to demonstrate a trend. There is no excuse for not tracking bilirubin levels in a jaundiced baby.
Ø Doctors failing to examine a baby for signs of acute bilirubin poisoning. This is especially true when the parents report problems that might be consistent with high bilirubin levels, such as difficulty feeding, a stiff baby, a floppy baby, high-pitched cry, etc.
Ø Doctors disregarding a lab result in the erroneous belief that the level is so high that it must be a laboratory error. In a case I recently handled, the doctor told his patient’s parents that the bilirubin concentration reported by the lab of 37.2mg/dL (grossly and dangerously excessive) was a lab error and that they should not be concerned. Several days passed before any intervention was attempted, and by then it was already too late. Treatment should never be delayed in the face of dangerously high bilirubin levels
Ø Doctors making the decision to turn off the phototherapy lights to perform other diagnostic testing or procedures. If medical treatments are needed while a baby is undergoing phototherapy, they should be done under the lights. If that is not possible, i.e., the baby needs an MRI or X-ray, the lights should be left on as long as possible and treatment resumed at the very first opportunity as soon as the test or procedure is concluded. If there is some reason for the baby to leave the unit, the lights should be left on and taken with the child. This therapy should not be interrupted unnecessarily.
Ø Doctors who incorrectly believe that the degree of discoloration of a baby's skin is an indication of how high or low the bilirubin level is. Babies with severe discoloration may not have dangerously high levels, and babies with slight discoloration may have dangerously high levels--there is no correlation between the degree of discoloration and the actual blood level of bilirubin. The only way to know the level is to measure it. Visual examination is never sufficient reassurance that the levels are in a safe range.
Jaundice is common in newborns and usually is not an indication of a serious problem. Nevertheless, there are situations where levels can get too high and must be corrected with therapy to avoid serious, lifelong injury. If your child suffers from kernicterus, you need to consult with an experienced attorney immediately to determine whether a claim for medical negligence exists. Keep in mind that there is usually additional time given to a child to bring a lawsuit--so do not assume that if your child is more than a few years old their time has expired. Speak to a lawyer right away if you suspect your child may have been injured by high bilirubin levels.
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