Jaundice and CP

How Are Jaundice and Kernicterus Related to Cerebral Palsy?

By Scott Vezina

Cerebral palsy is a condition that occurs when the areas of the brain that control movement are damaged or develop abnormally. This damage can occur before, during or shortly after birth. It can also, though less commonly, occur in the first few years of life while the brain is still developing. Brain injury that results in cerebral palsy can have many underlying causes and is not always fully understood. Newborn jaundice, while usually harmless if identified and treated appropriately, can potentially cause the sort of brain injury that can result in cerebral palsy if not treated promptly.

What Is Jaundice?

Newborn jaundice is a term used to describe the yellowing of an infant's skin shortly after birth, and it's caused when a toxin called bilirubin accumulates in a baby's body. Bilirubin is a yellowish-brown substance that is created when red blood cells break down. Usually, bilirubin is eliminated in bowel movements or broken down in the liver, but a newborn's liver (especially in premature babies) is still developing and can have trouble removing bilirubin effectively.

Around 60 percent of all infants born in the United States develop jaundice within a few days of birth. While most infants have mild cases, babies with higher bilirubin levels must be monitored very closely. These infants are typically prescribed a special light therapy (also called phototherapy) that helps to break down bilirubin to a safe level, and severe cases may require a blood exchange transfusion. When severe jaundice is untreated for too long, bilirubin can make its way to the brain and cause a condition called kernicterus.

What Is Kernicterus?

Kernicterus is a type of permanent brain injury that occurs when bilirubin enters the brain. Depending on where this occurs in the brain, it can result in cerebral palsy, hearing loss, vision problems, seizures or intellectual disabilities. This affects can be relatively mild if identified and treated early but can potentially result in death if treatment is withheld.

Kernicterus is almost entirely preventable, but unfortunately still occurs in some infants. To reduce the chance of jaundice progressing to kernicterus, the CDC recommends checking babies for jaundice every 8 to 12 hours in the first 48 hours after birth and again 2 - 3 days after leaving the hospital. Bilirubin levels can be checked by placing a light meter on the baby's head, and elevated readings can be confirmed more precisely with a blood test.

Can Jaundice Be Detected at Home?

While babies should be screened by a medical professional for jaundice while in the hospital and a couple of days after being discharged from the hospital, there are also signs of bilirubin toxicity that parents can watch for at home. In babies with light skin, a yellow tint is usually apparent. In babies with darker skin, this yellowing may be harder to see. In these cases, you may be able to press on the baby's skin and see the area turn yellowish. A yellow tint may also be visible in the whites of their eyes. Other symptoms of bilirubin toxicity include:

• difficulty waking up or falling asleep
• lack of wet diapers
• unusual fussiness
• poor feeding
• high-pitched crying
• backward arching of the neck or back

Can Jaundice Really Cause Cerebral Palsy?

Because newborn jaundice is so commonplace, there is a frequent misconception that it isn't a big deal and will clear up on its own. While that may be true in some cases, a severe case of jaundice can lead to permanent brain injury if left untreated, and a diagnosis of cerebral palsy is possible.

In general, except in rare cases of medical malpractice, otherwise healthy infants are unlikely to develop the extreme form of jaundice that would be required to cause cerebral palsy. That said, when babies are born too soon, have a blood disorder, have a blood-type incompatibility with their mother, develop bruising following a difficult birth, suffer from low oxygen levels, develop a blood infection and those born with liver problems are all at an elevated risk of developing the severe form of jaundice that has the potential to cause cerebral palsy or other types of brain injury. In these babies, it's essential that healthcare providers closely monitor bilirubin levels and provide treatment when needed.

If you believe your baby is suffering from jaundice, bring it to your doctor's attention immediately so that treatment, if necessary, can be started as soon as possible. Kernicterus and cerebral palsy due to jaundice are easily prevented, but the affects cannot be reversed if it has already been allowed to occur.