Kernicterus shouldnât happen. We prove why it did.
Kernicterus and severe hyperbilirubinemia are not just ânewborn jaundiceâ, they are medical emergencies that can cause lifelong brain injury when dangerously high bilirubin levels go unrecognized or untreated. Most jaundice is common and manageable, but kernicterus is often preventable with timely screening, risk assessment, and prompt treatment such as phototherapy or, when needed, exchange transfusion. When hospitals and providers miss warning signs – poor feeding, extreme sleepiness, high-pitched cry, arching, or rising bilirubin for the babyâs age – the consequences can be devastating; movement disorders, hearing loss, developmental delays, and permanent disability.
If your child was diagnosed with kernicterus or suffered complications from severe neonatal hyperbilirubinemia, you deserve clear answers about what happened and whether it could have been prevented. Our team investigates medical records, consults leading experts, and helps families pursue accountability and the resources needed for lifelong care.
Information About Kernicterus & Hyperbilirubinemia
How do hyperbilirubinemia and kernicterus develop?
Hyperbilirubinemia happens when a newbornâs bilirubin level rises faster than the infantâs liver can clear it. Most jaundice is mild, but if levels get very high, especially unconjugated bilirubin. Bilirubin can cross the bloodâbrain barrier and injure the brain. That spectrum of injury ranges from acute bilirubin encephalopathy to its chronic, permanent form, kernicterus.
What are the warning signs and symptoms?
Early/acute bilirubin encephalopathy (urgent): growing jaundice with poor feeding, extreme sleepiness, hypotonia (floppiness), high-pitched cry; can progress to arching/opisthotonus, fever, and seizures. Chronic kernicterus can leave movement disorders (athetoid cerebral palsy), auditory neuropathy/hearing loss, gaze abnormalities, and dental enamel issues; cognition may be relatively spared. Seek immediate care if acute signs appear.
Who is at higher risk?
Two sets of risks matter:
1. Risks for developing high bilirubin (more production or less clearance):
- Hemolysis (ABO/Rh incompatibility, G6PD deficiency), prematurity/late-preterm birth, bruising/cephalohematoma, dehydration/poor intake in early breastfeeding, East Asian ancestry, sibling with jaundice, maternal diabetes.
2. Risks that increase bilirubin neurotoxicity at a given level (lower âsafeâ threshold):
- Prematurity, hemolysis, sepsis, low serum albumin, clinical instability. These factors lower the AAP treatment thresholds and trigger earlier escalation.
How are severe hyperbilirubinemia and kernicterus prevented and treated?
- Universal screening + timely follow-up. Bilirubin testing before discharge and risk-based follow-up reduce severe cases. The 2022 AAP guideline sets age-in-hours curves and lower treatment thresholds when neurotoxicity risk factors are present. Tools (e.g., BiliTool/PediTools) map a babyâs value to the right action.
- Phototherapy. First-line therapy to lower bilirubin; use âintensive phototherapyâ when indicated.
- IVIG for isoimmune hemolysis. Consider when hemolysis (e.g., Rh/ABO incompatibility) is driving a rapid rise.
- Exchange transfusion. For critical levels or any neurologic signs; admit/transfer when bilirubin is within ~2 mg/dL of exchange threshold per AAP-aligned summaries.
- Escalation of care protocols. The AAP emphasizes early NICU transfer, hydration, frequent bilirubin checks, and addressing underlying causes (infection, hemolysis) when near thresholds.
When to consult with an experienced birth injury attorney?
Hyperbilirubinemia is common and usually manageable; kernicterus is rare and largely preventable with proper screening, risk-adjusted thresholds, and prompt treatment. If your child was harmed, our team can review what should have happened under the 2022 AAP standard of care and whether misses contributed to the outcome.
With birth injuries such as kernicterus, the best course of action is to consult with skilled attorneys like those at McEldrew Purtell as soon as possible. Although filing suit may seem like a secondary concern when dealing with an infantâs health, both New Jersey and Pennsylvania law state that birth injury cases must be filed within two years from the date of injury â other states set their statutes of limitations as short as one year for such cases.
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