How to Spot Kernicterus in Newborns

Latest update: April 19, 2021

Author Name: Heidi Holvoet, PhD

Recognizing kernicterus in your newborn baby is key to prevent severe brain damage. Symptoms of this excessive form of jaundice are extreme sleepiness, crying with a high pitch and being floppy.

Now that sleepiness symptom may be a bit confusing ...

Most newborns are quite sleepy most of the time at first. And you may be more than happy to enjoy these days and weeks in which she sleeps a lot. Which is a good idea by the way, it helps you catch up on some sleep after a possible tiring delivery.

But make a note of the list of symptoms below to look out for. You will then spot anything excessive in time so your baby can be treated if necessary.

What is kernicterus?

It is the form of brain damage that can occur as a consequence of extreme jaundice.

The very common and usually harmless jaundice in newborns - baby looks yellow - is caused by a substance called bilirubin.

If the levels become extremely high, the bilirubin can reach the brain tissue and cause brain damage. That is what doctors call kernicterus.

How to recognize?

The typical symptoms of kernicterus are:

  • Extreme sleepiness and lethargy i.e. it is all the time difficult to wake up your newborn baby completely. Or if she does wake, she seems to doze off again immediately.

    This also means that it is difficult to feed well. Partly, your baby will probably suckle a little, even while asleep. But to take a full good feed, she must be awake for a while.
  • A lot or little muscle tension. Baby has her muscles very tense (cramping up) or on the contrary not seem to have much muscle tension.
  • Arching back and spine, lying in strange/unnatural positions.
  • Crying a very high-pitched cry, i.e. screaming rather than crying normally.
  • Fever.

Fever is of course very common and happens with so many issues, even a simple virus can cause it. But for a newborn baby, fever is always a sign to see your doctor right away, regardless of the possible cause.

What to do?

As soon as you suspect one or several of the above symptoms, you should consult a doctor immediately. If your general practitioner or pediatrician nearby is not available, go to the nearest hospital emergency room.

If the symptoms are occurring, that means that damage is being done already.

But, as child neurologist Dr. S. M. Shapiro MD, MSHA stresses, that does not mean that it's too late! The damage may still be reversed if treatment starts quickly, and worse harm can be prevented.

Dr. Shapiro urges parents to avoid any delay in treatment, as he explains here.

To avoid any unnecessary damage, he prefers over-treatment rather than treating too late. This means for example starting treatment while still awaiting lab tests rather than wait until damage is already done.

Medical treatment will consist of intensive photo therapy (blue light) and if need be a blood transfusion (to quickly get rid of the bilirubin in the blood). As always, hydration is crucial so if necessary, baby will be tube fed for a while.

Finally, as with all warning articles, please don't let this one overly scare you. This is a rare condition which is not very likely to occur for your baby. But it is is very important to be aware of its existence and see a doctor if you recognize the symptoms.

How to deal with your newborn crying gently?