Can Jaundice Cause Brain Damage?

Jaundice can cause brain damage. An excess of bilirubin in the blood causes jaundice and a yellow-orange skin tone. Brain damage can occur when bilirubin levels get too high and the bilirubin enters the baby’s brain tissue. 

High bilirubin levels can cause serious forms of brain damage and other problems, such as:

About half of babies have jaundice shortly after birth.In babies, jaundice usually disappears around 1 – 2 weeks after birth. 

What is bilirubin? 

Bilirubin is the end product of red blood cell breakdown. 

Everybody experiences red blood cell breakdown, but in newborns, the breakdown is at a higher rate. This is because babies have more red blood cells than adults, which is part of the transition from being in the womb. 

Fetal red blood cells have a short life span. This leads to a lot of cell breakdown and excess bilirubin in the blood. 

Babies have a slower time removing bilirubin from their bodies. In the womb, the placenta removes the bilirubin. After birth, the baby’s liver begins removing the bilirubin. This process can take some time because some newborns’ livers are slower to develop than others.

How Are Jaundice and High Bilirubin Levels Treated? 

Some babies have a condition called hyperbilirubinemia, which means their blood has excessive amounts of bilirubin.

Treating high bilirubin levels is easy. Medical staff have several options to treat a baby with hyperbilirubinemia:

  • Phototherapy: medical staff place the baby under special lights to reduce bilirubin levels. The baby must be naked with their eyes covered.
  • Fiberoptic blanket: an alternative to phototherapy where the treatment light comes from optical fibers in a special blanket. This treatment is more comfortable for the child and allows them to nurse close to their parents.
  • Blood exchange transfusion: the baby’s blood is slowly removed and replaced with donor blood. The donor blood will have lower amounts of bilirubin.

a baby laying under a phototherapy light for jaundice treatment

Testing for high levels of bilirubin

All newborn babies should have their bilirubin levels checked every 9 – 12 hours in the first 2 days of life, at a minimum. The levels should be checked again at 5 days of life.

To test for hyperbilirubinemia, medical staff place a light meter on the baby’s head. This is called transcutaneous monitoring. If the bilirubin level is high, the next test is a blood test. 

A blood test will show the total serum bilirubin level, which is a more accurate assessment of bilirubin in the blood. 

When the serum level is high, the baby will receive treatment. If the transcutaneous level is high, treatment may begin while waiting for the blood test results. Repeat blood test samples should be taken to ensure that the treatment is working.

High bilirubin levels require treatment when one or more of the following occurs:

  • A rapid rise in the baby’s bilirubin level occurs
  • Total serum bilirubin levels are greater than the 95th percentile
    • Compared to what is normal for a newborn of a certain age (in hours)
  • The baby has jaundice within the first day of life
  • There is a high level of conjugated bilirubin
    • Conjugated bilirubin, or direct bilirubin, is bilirubin already processed by the liver.

What Are the Risk Factors for High Bilirubin Levels and Jaundice?

Risk factors for jaundice and hyperbilirubinemia include the following:

  • Preterm birth
  • Feeding problems
  • Having a sibling with jaundice
  • Darker skin color
  • Fetal distress and HIE
  • Mismatch in blood type between mother and baby (Rh incompatibility)
  • Polycythemia (high red blood cell level)
  • Bruising
  • East Asian or Mediterranean descent
  • Certain drugs called sulfonamides (e.g. trimoxazole)
  • Crigler-Najjar syndrome type I
  • Gilbert’s syndrome
  • G6PD deficiency

What Are The Causes of High Bilirubin Levels and Jaundice?

Many conditions can cause high bilirubin levels.

Severe hyperbilirubinemia can occur with disorders or conditions increasing red blood cell breakdown. These conditions include the following:

  • Rh incompatibility
  • A cephalohematoma
    • A type of bleeding under the scalp, usually caused by a difficult delivery
  • An infection such as sepsis
  • A lack of certain key enzymes
  • A high red blood cell level, which is more common in babies who are small for gestational age or twins
  • Abnormally shaped red blood cells
  • A combination of a macrosomic (large) baby and a diabetic mother

Factors that make it harder for a baby’s body to remove bilirubin can also cause severe hyperbilirubinemia. These include:

  • Certain medications
  • Infections such as syphilis and rubella, as well as sepsis and meningitis
  • Diseases that affect the biliary tract or liver, such as cystic fibrosis
  • A lack of oxygen in the baby’s tissues (hypoxia)
  • Certain genetic or inherited disorders.

Babies who are breast-fed can get the following types of jaundice.

Breastfeeding jaundice 

Newborns who have problems nursing or whose mother’s milk is slow to come in may develop jaundice. This type of jaundice is also called breastfeeding failure jaundice.

Breastfeeding jaundice usually occurs within the first week of life. If the baby is feeding poorly, the baby can lose weight and become dehydrated. Hyperbilirubinemia may develop if these factors lead to the baby’s blood pressure dropping. Low blood pressure prevents the body from getting rid of bilirubin quickly.

Breast milk jaundice

When babies have jaundice that lasts after the first week of life, it is usually breast milk jaundice. This type may last for a month or more at lower levels of bilirubin. The cause may be  breast milk substances affecting the breakdown of bilirubin in the liver.

How Can Jaundice and Brain Damage Be Prevented?  

Regular and frequent feeding of a newborn can greatly reduce the chance of them having high bilirubin levels. Feeding should occur 8 – 12 times a day for the first several days of life.

All pregnant patients should have blood type and antibody tests. If the blood is Rh negative,  follow-up testing of the baby’s umbilical cord should occur. 

Medical staff should check the baby’s bilirubin levels frequently, regardless of hyperbilirubinemia risk factors. If a newborn goes home shortly after birth, a follow-up visit with the physician should occur within the first seven days after birth.

Other ways to prevent brain damage caused by hyperbilirubinemia include:

  • Avoiding forceps or vacuum extractors during delivery 
    • This can help prevent brain bleeds (cephalohematomas) that cause hyperbilirubinemia.
  • Starting treatment early.
    • If the physician does not believe the accuracy of a test and wants to confirm it, treatment can start while waiting for results. There are no downsides to treating a baby with phototherapy. Knowing the baby’s blood type helps in case an exchange transfusion is necessary.
  • Continuing testing while the baby receives phototherapy.
    • Phototherapy should not be postponed or interrupted because of testing. Most tests can occur under the lights, or staff can move the lights with the baby for an outside test.
  • Comparing bilirubin levels to hour-specific norms. 
    • Safe bilirubin levels in a baby vary by hours of age. A day-old baby will have different markers if they are 24 hours old versus 47 hours old. closer to 24 hours of age will have different markers than a day-old baby closer to 47 hours of age.

How Does Jaundice Cause Brain Damage?

Bilirubin is a brain toxin. When bilirubin levels get too high, bilirubin can pass through the blood-brain barrier and enter brain tissue. Buildup of bilirubin in the brain can cause long term damage called kernicterus.

Once bilirubin enters the brain, it builds up in the gray matter. Gray matter plays a major role in several brain functions: 

  • muscle control
  • seeing
  • hearing
  • memory
  • emotions
  • decision-making
  • speech and self-control. 

Damage to gray matter can cause:

  • cerebral palsy
  • seizure disorders
  • intellectual disabilities and speech
  • sight and hearing problems 

Kernicterus usually causes athetoid cerebral palsy.

Types of Kernicterus (Brain Damage from Jaundice)

Kernicterus can be classified into 3 different types of encephalopathy (brain injury). 

Acute bilirubin encephalopathy (ABE)

Acute bilirubin encephalopathy (ABE) is a sudden onset of high bilirubin in the brain.  Symptoms of ABE include the following:

  • The baby is too stiff (has hypertonia) or too floppy (has hypotonia).
  • Fever
  • Seizures
  • Lethargy
  • Decreased feeding
  • High-pitched cry
  • Setting sun sign (eyelids are retracted up but eyes gaze down)
  • Spasmodic torticollis (neck involuntarily turns up, down, left or right)
  • Opisthotonus (severe hyperextension and spasticity whereby the body is extremely arched)

If high bilirubin levels are not promptly decreased, ABE quickly progresses to chronic (long-term) bilirubin encephalopathy (CBE).

Chronic bilirubin encephalopathy (CBE)

Chronic bilirubin encephalopathy (CBE) is when there are severe injuries in the brain caused by bilirubin. Once CBE occurs, reducing bilirubin levels in the baby will not reverse the progression.  A baby with CBE may exhibit the following:

  • Athetoid cerebral palsy and/or dystonia (involuntary muscle movement)
  • Hearing problems and auditory neuropathy (ANSD)
  • Eye problems such as nystagmus, strabismus, impaired upward or downward gaze, and/or cortical visual impairment.

These medical problems are associated with injuries in parts of the brain stem and basal ganglia.

Subtle bilirubin encephalopathy (SBE) 

Subtle bilirubin encephalopathy (SBE) is a long-term state of mild brain dysfunction. A child with SBE will have neurological, movement, and learning disorders, and some hearing problems are also likely to occur.

Brain Damage From Jaundice Is Preventable

When a baby has hyperbilirubinemia, the only way to prevent brain damage is to promptly treat them with phototherapy or exchange transfusion. There is no excuse for a baby to develop brain damage caused by high bilirubin levels. Hyperbilirubinemia is very easy to test for and treat.

If your baby has suffered a brain injury after a jaundice diagnosis, medical professionals may have acted improperly and not in time. If you have worries about your child’s future, speak with an attorney today. A birth injury lawyer can help advocate for your family and get the answers your family deserves.

Physicians must remember that when signs of bilirubin-induced brain damage first appear, it is usually not too late to treat the baby. When a baby is jaundiced and signs are present, damage continues to occur. The sooner the bilirubin is reduced, the better, and the less severe the brain damage will be in most cases. Hyperbilirubinemia is a medical emergency, and delay makes damage worse.

ABC Law Centers: Advocates For Children With Birth Injuries For Over 25 Years

When you need the help of a birth injury lawyer, it is very important to choose a lawyer and firm that focuses solely on birth injury cases. ABC Law Centers: Birth Injury Lawyers is a national birth injury law firm that has been helping children for over 25 years. 

Jesse Reiter, president of the firm, has been focusing his practice solely on birth injury cases for over 28 yearsMost of his cases involve children suffering from hypoxic ischemic encephalopathy (HIE) and cerebral palsy.The lawyers at ABC Law Centers: Birth Injury Lawyers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

If your child was diagnosed with a permanent disability, such as kernicterus, cerebral palsy, a seizure disorder, or hypoxic-ischemic encephalopathy (HIE), our team can help. We are here to support and advocate for your child. We have helped families like yours throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. We give personal attention to each child and family we represent. 

Our nationally recognized firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. 

Contact ABC Law Centers: Birth Injury Lawyers at 248-593-5100 for a free case evaluation. Our award-winning lawyers are available 24 / 7 to speak with you.