It is common for babies born in The U.S. to have some level of jaundice at birth. Jaundice is a condition in which bilirubin, which is a pigment that is normally broken down in the liver, builds up and causes the baby’s eyes, skin, and tissues to appear yellow. While jaundice might sound scary, it is rare for it to cause problems for infants. In most cases, jaundice will go away within a couple of days as the baby’s liver breaks down the excess bilirubin. The infant will then continue to develop normally. However, in rare cases, an infant might develop kernicterus, which is jaundice that is out of control. Here is some information about kernicterus, its causes, and when it might form the basis of a viable malpractice claim from the Philadelphia Birth Injury attorneys at Raynes & Lawn.
What Is Kernicterus?
Jaundice affects up to 60% of infants born in the U.S. and does not always signal a problem. Neonatal jaundice occurs when the fetus’s immature liver breaks down red blood cells and can’t keep up with the process. The byproduct is bilirubin, which can accumulate in the infant’s blood and cause the newborn to appear yellow.
While most cases of jaundice will clear within a couple of days without further problems, rare cases can develop into out-of-control jaundice that can result in kernicterus. This is a type of preventable damage to the brain that can occur in some babies with uncontrolled jaundice.
Kernicterus can occur when the level of bilirubin in an infant’s blood remains too high and isn’t appropriately treated by medical professionals. If kernicterus develops, the infant can suffer brain damage. Kernicterus is also referred to as bilirubin-induced neurologic dysfunction (BIND) or bilirubin encephalopathy. Infants who have increased levels of bilirubin and who are showing signs of brain dysfunction need immediate treatment to prevent or minimize damage to the brain. If the infant is properly treated, jaundice can be managed easily. However, if the infant does not receive prompt treatment, they can develop kernicterus and permanent brain damage.
Symptoms and Signs of Kernicterus
If jaundice is not properly treated, bilirubin can build up in the baby’s blood. Since jaundice is common in newborns and often clears up on its own, some doctors fail to promptly treat it. However, if they fail to promptly treat an infant’s jaundice, the levels of bilirubin can get too high and could potentially result in kernicterus and severe brain damage without adequate treatment.
If you see any of the following symptoms and signs of jaundice in your baby, you should talk to your doctor immediately:
- Skin beginning at the head with a yellowish or orangish hue
- Trouble sleeping
- Problems feeding with either the breast or bottle
- Decreased frequency of urination and bowel movements
- Severe irritability/fussiness
If you notice the following signs of kernicterus, you should seek immediate medical attention for your baby:
- Uncontrollable, shrill crying
- Excessive drowsiness
- Lack of energy
- Spasms in the muscles
- Downward drift in the eyes/abnormal eye movements
- Rigid or limp muscles and body
- Sensory issues
- Problems with the development of motor skills
- Tooth enamel with a stained appearance
Risk Factors for Kernicterus
All babies have a risk of developing kernicterus. It is unclear why some babies develop out-of-control jaundice resulting in kernicterus while others do not. Some of the factors that have been associated with increased levels of bilirubin in the blood resulting in jaundice and potential kernicterus include the following:
- Rh incompatibility between the mother and baby
- Preterm birth
- Cephalohematomas/bleeding under the scalp
- Being of Mediterranean or east Asian descent
- Siblings who were jaundiced at birth
- Genetic factors such as reduced levels of glucose-6-phosphate dehydrogenase
- Poor feeding or suckling
Infants typically have the highest levels of bilirubin in the blood between three to five days following birth. During the first two days following birth, newborns should be checked for signs of jaundice every eight to 12 hours. They should be checked again before they reach five days old.
Doctors should check your infant’s bilirubin level before discharging them from the hospital by using a light meter. If the meter returns a high result, a doctor can test your baby’s blood to measure the levels of bilirubin. If the results are too high, your baby should receive treatments based on how many hours old they are and the presence of certain risk factors. Following treatment, your baby’s doctor might order additional blood tests to ensure the bilirubin levels are decreasing to a normal range.
If your child has mild jaundice, they might not need treatment. However, if the doctor determines that the bilirubin levels in their blood are excessive, or if certain risk factors are present, the doctor might recommend treatment. Some of the treatment options are detailed below.
Supplementing Breast Milk and Formula
Babies who aren’t feeding or suckling enough might not be getting enough fluids. In that case, your baby might not have enough fluids to allow them to rid themselves of the excess bilirubin levels through stools and urine. A newborn should have six or more wet diapers each day. Stools should change colors from dark green to yellowish when the infant is getting enough nutrition. An infant should also appear satisfied when they have had enough food. If your baby is not getting adequate fluids and nutrition, your doctor might supplement their feeding with formula.
Phototherapy using a blue light might be used to help the infant break down bilirubin in the blood. The light might be used in the hospital or home and is applied to the infant’s skin. The blue light helps the infant’s body to break the bilirubin down and pass it through urine or stools. Doctors used to recommend exposing infants to sunlight to help them break down bilirubin to treat jaundice, but they no longer do because of the potential of sunburn. Phototherapy is relatively safe. However, it can cause some temporary side effects, including diarrhea and rash.
An infant will need to get enough fluids while they undergo phototherapy. While bottle feeding or breastfeeding will continue, the doctor might also supplement their fluids intravenously to combat severe dehydration.
If your baby doesn’t respond to other treatments, your doctor might recommend a blood transfusion. This can help to quickly reduce the levels of bilirubin in the blood. However, a blood transfusion will likely only be recommended if your baby has excessively high levels of bilirubin and is showing symptoms of possible brain damage.
Potential Complications of Kernicterus
Some of the complications that are associated with kernicterus include the following:
- Deafness/hearing loss
- Teeth problems
- Vision problems
- Athetoid cerebral palsy
- Intellectual disabilities
Is Kernicterus Caused by Medical Malpractice?
Kernicterus is preventable and frequently occurs when nurses, doctors, and other medical professionals fail to identify and promptly intervene when infants have jaundice and excessively high levels of bilirubin in their blood.
If a baby shows obvious signs of jaundice, doctors should test their bilirubin levels using a light meter. If the results from the light meter indicate high levels of bilirubin, the medical professionals should then perform blood tests to accurately measure their levels and then provide prompt, appropriate treatment.
Doctors and nurses should examine infants for signs of jaundice and be able to visually distinguish between mild jaundice and more severe jaundice based on the newborn’s age in terms of hours, the presence of risk factors, and the need to assess the levels of bilirubin and properly treat the infant. They should then ensure they follow up to ensure the bilirubin levels have decreased following treatment.
The following examples are among the most common types of medical mistakes leading to kernicterus that doctors and nurses sometimes make:
• Failing to properly monitor the infant for signs of jaundice every eight to 12 hours
• Failing to check the infant’s bilirubin levels before discharging them from the hospital
• Failing to provide immediate treatment after receiving the initial results of high bilirubin levels
• Interrupting phototherapy or delaying it while testing the infant for the risk of blood transfusions
• Failing to properly examine the baby for signs of kernicterus
• Failing to compare bilirubin serum levels to the expected norms based on the age in hours of the infant
Proving Medical Malpractice in Birth Injury Kernicterus Cases
According to the U.S. Centers for Disease Control and Prevention (CDC), a baby should never suffer brain damage caused by untreated jaundice leading to kernicterus. Most cases of kernicterus involve medical negligence caused by a provider’s failure to identify jaundice, test for bilirubin levels, or provide appropriate and immediate medical treatment when a child’s bilirubin levels are too high.
Jaundice should be immediately apparent, and doctors should recognize it by looking at an infant. Failing to properly monitor an infant and provide appropriate treatment can result in devastating consequences. If an infant develops kernicterus, they can suffer severe brain damage resulting in a lifetime of care.
In Pennsylvania, you can’t file a medical malpractice lawsuit against a doctor or another healthcare professional for your child’s kernicterus and resulting complications without first having the medical records reviewed by a medical expert. To prove medical malpractice, you must present evidence showing each of the following elements by a preponderance of the evidence:
- Establishment of a provider-patient relationship
- Existence of an expected medical standard of care
- Deviation of the provider’s treatment from the expected standard of care
- Substandard treatment caused the development of the infant’s kernicterus and resulting brain damage
- Family and the infant suffered calculable damages as a result
A medical expert must determine the expected standard of care for the doctor or another medical professional involved in the case. The standard of care is what a reasonably competent provider in the same area of practice and geographic region would have done under the same treatment conditions. Once the standard of care has been determined, the expert will then examine the medical records, including doctors’ notes, nurses’ notes, lab tests ordered, and others to determine whether the provider’s treatment failed to meet the standard of care. If it did, the expert will then look at whether the substandard care was the direct or proximate cause of the infant’s development of kernicterus and the resulting brain damage.
If the medical expert believes that the medical provider’s care fell below the expected standard and caused your baby’s condition, you can file a medical malpractice lawsuit. Your attorney will have to file a certification that your case has been reviewed by a medical expert and that the provider’s care amounted to medical malpractice. They will then investigate what happened and work to gather strong evidence to support your claim. In many cases, malpractice claims might be resolved through settlement negotiations short of trial. However, your attorney will prepare your case as if it will be litigated at trial and will be prepared to fight for your family’s rights in court if necessary.
Statute of Limitations
Pennsylvania has a statute of limitations in place for medical malpractice claims, which sets a deadline for when a lawsuit must be filed. This law is found in 42 Pa.C.S. § 5524. Under the statute of limitations, the deadline for filing a malpractice case against the medical providers who were responsible for your child’s kernicterus is two years from when the injury occurred. However, Pennsylvania follows a discovery rule, which means the limitations period will be tolled and won’t start to run until the date you discovered or reasonably should have discovered your child’s injuries were caused by malpractice.
Medical malpractice cases are complex and take time to investigate. This makes it important for you to seek help from an experienced birth injury attorney as soon as possible after you learn about your child’s diagnosis. When you retain a lawyer quickly, they will have more time to build your case, consult with medical experts, and preserve evidence so that it can’t be lost.
Compensation That Might Be Available
Each malpractice case based on kernicterus has unique facts that can influence how much it might be worth. There isn’t a set value for a birth injury kernicterus case. However, the damages that might be available include compensatory damages for your economic and noneconomic losses, including the following types:
- Past and future medical expenses for your child’s medical care
- Past and future rehabilitation and therapy costs
- Mobility devices if necessary
- Your child’s physical pain and suffering
- Emotional distress
- Loss of the ability to enjoy life
- Other losses
When you meet with your attorney, they will calculate the value of your case based on the severity of your child’s injuries, the conduct of the medical providers, and others. You will then be provided with a range of values for your potential case so that you have a better idea of what you might expect. Pennsylvania does not cap compensatory damages.
In some cases, punitive damages might also be available. These are additional monetary sums that might be awarded in cases in which the actions of the defendant were especially outrageous and are not available in all cases. If punitive damages are awarded, they are paid on top of any compensatory damages that you might receive. Pennsylvania caps the punitive damages in a case at no more than 200% of the economic damages.
Consult a Kernicterus Lawyer in Philadelphia
If your baby developed kernicterus and permanent brain damage because of the negligent care provided by a doctor or another medical provider, you should talk to a kernicterus lawyer in Philadelphia at Raynes & Lawn. We can review your case and provide you with an honest assessment of its viability. We have more than five decades of experience fighting for the rights of families and victims who have suffered harm because of medical malpractice. Call us for a free consultation at 1-800-535-1797.
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