Early Hours of Life Critical for Babies With Deadly Jaundice
May 2, 2001 (Washington) -- America's hospitals are being
alerted to the risks of a life-threatening, yet almost always preventable
condition that strikes infants in the early days of life.
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) says medical professionals should be on the alert for
kernicterus -- a rare disorder resulting from toxic levels of bilirubin in the
"My family knows first hand the tragic and profound
consequences of kernicterus. It has challenged our lives, emotionally,
physically, and financially," says Sue Sheridan, spokeswoman for PICK,
Parents of Infants and Children with Kernicterus. Her 6-year-old son Cal will
live with the consequences of the condition for the rest of his life.
Bilirubin, which causes jaundice, is a natural by-product of
decomposing red blood cells, but when it's present at dangerous levels, it can
cause severe brain damage or even death in an infant. Although most doctors
only see one or two cases during their careers, there has been something of a
re-emergence of the condition since 1984. One registry counts 90 cases since
1984 in the U.S. That's not many out of an estimated four million live births
in America, so doctors may be inclined to underestimate these at-risk
Jaundice in a mild form affects about one-half of all newborns and is likely
to go away in a few days. However, if the level of bilirubin unexpectedly
ratchets up, it can cause severe brain damage similar to the type caused by
cerebral palsy. There is no effective treatment once it progresses to that
The irony is that high levels of bilirubin are highly treatable
simply by putting a jaundiced baby under a bright florescent light. A blue
light has also proven an effective therapy for bringing the bilirubin down.
"They [doctors] have a lower level of concern, and that's
understandable, because it's a rare problem," Jeffrey Maisels, MD, chairman
of an American Academy of Pediatrics' subcommittee on neonatal health at the
William Beaumont Hospital in Royal Oak, Mich., tells WebMD. Along with the
JCAHO, the Academy is also issuing new guidelines for managing the
What the JCAHO is suggesting as a new preventive strategy is to
monitor a large number of children who have elevated bilirubin with blood
tests, even though their jaundice is likely to go away in a matter of days.
However, the trend toward shortened hospital stays means that
it's easy to miss jaundice if it shows up in an apparently healthy baby after a
day or two. The federal government says that insurance companies only have to
pay for the first 48 hours in the hospital after the baby is born. But some
parents want to go home sooner.
"Physicians didn't automatically make the adjustment that
was necessary to recognize that the baby going home in 36 hours is not the same
as the baby going home in 70 hours," says Maisels.
According to the JCAHO, the risk factors for kernicterus
include the following:
- Jaundice within 24 hours of birth
- Poor breastfeeding
- Siblings with jaundice
- East-Asian or Mediterranean descent
The accrediting body suggests several fixes for the
- Blood tests to predict the risk of extreme jaundice in babies showing any
symptoms in 24 hours
- Follow-up on all newborns within 48 hours by a doctor or nurse, or consider
delaying hospital discharge
- Provide parents with educational material about the condition
- Make sure adequate phototherapy equipment is available
During on-site accreditation visits, JCAHO will ask hospitals
how they intend to protect newborns from kernicterus.