Jaundice, Kernicterus & Hyperbilirubinemia

Kernicterus, a brain injury caused by excessive bilirubin is described by physicians as a “never event”.  It is referred to as a never event not because it never happens, but because it should never happen.

Jaundice is very common, occurring in over 50% of births.  Jaundice occurs with excessive bilirubin, a byproduct of the breakdown of red blood cells due to the newborn’s liver not being able to properly process the bilirubin.  The treatment for jaundice is phototherapy which alters the bilirubin from a toxic to non-toxic form that is easily eliminated by the newborn.

High levels of bilirubin, if left untreated, can result in the newborn suffering a brain injury.

Kernicterus is a never event because it is so easy to test bilirubin levels by a blood sample from a heel prick and by way of skin probe.  Some babies are at risk of having increased bilirubin –  including those born at 35 – 36 weeks gestation, males, those with visible bruising, and newborns with siblings who had severe hyperbilirubinemia.

In 2004, the American Academy of Pediatrics published clinical practice guidelines on the management of hyperbilirubinemia and in 2007, the Canadian Pediatric Society published its own guidelines for the Detection, Management and Prevention of Hyperbilirubinemia.

Regrettably, despite these guidelines, brain injuries due to kernicterus still occur in Canada.  These preventable injuries result when at risk newborns are not identified and where the healthcare professionals fail to use simple tests to identify a child at risk of developing a preventable brain injury.