Kernicterus is an increased accumulation of bilirubin in the brain, which can occur in newborns. Various causes and mechanisms of development play a role here. Jaundice is a jaundice that can occur in newborns as well as adults due to increased bilirubin levels, especially in the eyes and skin.
Bilirubin is a breakdown product of hemoglobin, which can circulate freely in the blood due to disorders of the blood cells or through metabolic processes in the liver. If newborns experience a rapid increase in bilirubin, it can cross the blood-brain barrier and cause serious damage to the brain. In the worst case, this brain disease, the so-called "encephalopathy", even lead to death.
Jaundice can have many causes and, in addition to disorders of the blood cells, may also be due to diseases of the liver or biliary tract. In kernikterus, however, there is the peculiarity that jaundice is mainly caused by blood cell disorders, as only in this part of the circulation is bilirubin chemically able to cross the blood-brain barrier. In the newborn, various processes can cause red blood cell disintegration and destruction, releasing more bilirubin.
Reasons for this are:
On the other hand, there may also be damage to the blood-brain barrier, which can cause even normal bilirubin levels Kernikterus.
This case can occur at:
of the newborn.
The neurological symptoms in a newborn are not as clear as they are in adults, so it is important to be aware of certain signs of the child's behavior.
In the early stages of kernicterus, the child may feel drowsy and may be attracted by poor drinking and sedentary lifestyle.
Later, the symptoms may turn into an increased excitability with shrill screaming and a tight muscle tone of the spine. In addition, the consciousness of the newborn decreases, so that in the course of a coma can occur with continued increased muscle tone and seizures.
Even in the long term, kernicterus can cause severe symptoms. These include a spastic paralysis of many muscles, a hearing impairment, a paralysis of certain eye muscles, and possibly a mental retardation.
The diagnosis of kernicterus is based on clinical abnormalities and laboratory tests. If the newborn child shows yellowing of the skin before the third or the 10th day of life, a laboratory examination should be carried out. If bilirubin levels in the blood are significantly elevated, further diagnostic tests should be sought to determine the cause of the increase.
Other blood levels may provide clues as to whether red blood cell degeneration, liver abnormalities, or a serious metabolic disease are behind jaundice. Indications of kernicterus and therefore involvement of the brain result from certain symptoms and neurological abnormalities of the child.
The most important therapeutic measure is the so-called "phototherapy". Here, the newborn is illuminated with blue light, whereby the bilirubin is transformed in the body so that it can be excreted through the intestine and the kidney. Phototherapy is useful only in certain cases of bilirubin elevation.
It may also be associated with side effects such as diarrhea, dehydration and, in the worst case, long-term leukemia.
From a certain bilirubin value phototherapy is not sufficient, so if necessary, a blood exchange transfusion must be performed. Kernicterus often already has such elevated levels that this therapy is performed immediately in the acute phase. Donor blood is transfused, which has the same blood group.
In order to prevent kernicterus, a regular and adequate nutrition of the child should be carried out early after the birth. Preference is given to breast milk, as well as protein-rich diet.
The duration of kernicterus can be difficult to specify. Several factors play a role here. For a short time, it is crucial that the trigger of kernicterus is resolved, that bilirubin levels are low, and that icterus responds quickly to therapy.
If the cause of bilirubin elevation is not found, kernicterus may continue and progress despite therapy. If possible, the values should be lowered within a few hours to days to prevent serious consequential damage. In the long term, however, irreversible damage can be sustained by the kernicterus.
The course of the disease can be very variable. In principle, kernicterus can be very acute or chronic. Crucial here is how brilliant the causal events are, how high the bilirubin levels increase and how well the therapy gets the event under control.
In the beginning, in most cases:
Then you can notice:
Only with a progressive suffering of the brain it comes to:
This acute disease is life threatening.
If it is survived, however, consequential damage to the brain can be impressive in the coming years. These are primarily neurological deficits such as:
The full extent of the damage can only be determined during the growing up in the following years.
A kernicterus is not an infectious event and thus not contagious. Certain circumstances of the mother, however, can provoke a kernicterus in several children in a row. This may be, for example, a rhesus incompatibility, whereby maternal antibodies destroy the blood of the child. Again, it is not a contagion in the strict sense.