Yellowing of the skin and eyes in infants and children is known as bilirubin encephalopathy, also referred to as kernicterus. It is a rare neurological condition that can occur due to high levels of bilirubin in the blood of newborns, leading to brain damage. Bilirubin is a yellow pigment produced when the body breaks down old red blood cells.
However, it’s important to note that bilirubin encephalopathy may be a sign of other serious underlying conditions. Therefore, a doctor may need to examine the baby and assess risk factors that could lead to hyperbilirubinemia (high bilirubin levels), in an effort to reduce those levels and protect the baby’s brain from damage.
According to Healthline, here is what you need to know about this condition:
What Is Bilirubin Encephalopathy in Newborns?
Bilirubin encephalopathy is a severe form of brain damage that occurs when excessive, untreated bilirubin builds up in the brain. It typically affects premature infants or those with extreme cases of untreated jaundice (hyperbilirubinemia).
When the newborn’s body is unable to properly process and eliminate bilirubin, it can accumulate and cross into brain tissue, leading to permanent brain cell damage.
Complications may include:
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Impaired cognitive and motor development
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Blindness
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Hearing loss
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Behavioral issues
That’s why it's crucial to detect and treat hyperbilirubinemia as early as possible to prevent kernicterus.
Causes of Bilirubin Encephalopathy in Newborns
Bilirubin is a natural byproduct of red blood cell breakdown. In a healthy infant, the liver processes and eliminates bilirubin efficiently. However, in babies with bilirubin encephalopathy, this system doesn't function properly, causing bilirubin to accumulate.
Key risk factors include:
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Hemolysis (Excessive Red Blood Cell Breakdown): Can result from blood disorders like Rh disease or hemolytic disease of the newborn.
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Liver Disorders: A poorly functioning liver may be unable to process bilirubin effectively.
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Bile Duct Obstruction: Prevents bilirubin from exiting the liver, leading to buildup.
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Blood Type Incompatibility: Differences between mother and baby’s blood types (e.g., A, B, O, or Rh) can trigger maternal antibodies to attack the baby’s red blood cells.
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Premature Birth: Preterm babies often have immature liver function, increasing their risk.
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Inadequate Feeding: Poor intake of breast milk or formula can slow bilirubin elimination.
Symptoms of Bilirubin Encephalopathy
Symptoms usually appear within a few days after birth, but in some cases, they may not show up until weeks later.
Common signs include:
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Yellowing of the skin and whites of the eyes
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Irritability or unusual fussiness
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Poor muscle tone or difficulty with muscle control
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Reduced Moro reflex (startle response)
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Difficulty breastfeeding or bottle feeding due to weak sucking reflex
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Changes in behavior and appetite
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In severe cases, worsening neurological symptoms
Diagnosis of Kernicterus in Newborns
Diagnosis involves identifying both high bilirubin levels and signs of brain injury. A doctor may take the following steps:
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Physical Examination: Checking skin and eye color, as jaundice may indicate high bilirubin.
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Blood Tests: Measuring serum bilirubin levels in the baby’s blood.
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Imaging Tests: In severe cases, ultrasounds or transcranial Doppler may be used to examine the brain.
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Brain Scans: MRI or CT scans may help detect actual brain damage.
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Medical History: The doctor will review the baby’s risk factors, such as blood type incompatibilities or liver problems.
Treatment of Bilirubin Encephalopathy in Newborns
The goal of treatment is to reduce bilirubin levels quickly and prevent further brain damage. The most common treatment options include:
Phototherapy
This is the primary treatment for neonatal jaundice. The baby is placed under a special blue light that converts bilirubin into a water-soluble form that can be eliminated through urine and stool.
Babies are usually undressed, except for a diaper, to expose as much skin as possible. Phototherapy may last several days, depending on bilirubin levels.
Exchange Transfusion
In severe cases or if phototherapy fails, a blood exchange transfusion may be necessary. This procedure replaces the baby's blood (which contains excess bilirubin) with donor blood, rapidly lowering bilirubin levels.
Blood Transfusion
Some infants may require a full blood transfusion to replace damaged red blood cells and reduce bilirubin levels. This also helps improve oxygen delivery to the brain.
Monitoring and Long-Term Care
After treatment begins, doctors continuously monitor bilirubin levels to ensure the therapy is effective and safe. In severe cases, babies may need ongoing care throughout childhood, such as:
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Physical therapy
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Occupational therapy
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Speech therapy
These interventions help children achieve their full developmental potential despite early brain injury.
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