KERNICTERUS

            There is a topic that I studied, that profoundly caused me to write something about it. It’s about KERNICTERUS. Kernicterus is  bilirubin-induced brain dysfunction. Apart from some diseases like phenylketonuria (PKU), galactosemia, and cretinism, that can cause mental retardation in babies, Kernicterus can also do the same. Fortunately, all the diseases that have been mentioned above are totally preventable. PKU, galactosemia, and cretinism can be prevented simply by screening the baby right after the delivery. But it is not the same with Kernicterus.

Kernicterus is caused by very high levels of bilirubin. Bilirubin is a yellow pigment that is created in the body during the normal recycling of old red blood cells. High levels of bilirubin in the body can cause the skin to look yellow (which is called jaundice).

In some cases when there are extremely high levels of bilirubin in the body or the baby is extremely ill, the substance will move out of the blood and collect in the brain tissue. This can lead to serious neurological complications, including brain damage and hearing loss.

Kernicterus usually develops in the first week of life, but may be seen up until the third week. Newborns with Rh hemolytic disease that may lead to hydrops fetalis are at high risk for severe jaundice that leads to this condition. However, kernicterus has been seen in apparently healthy babies. –  an excerpt from the medlineplus website.

look to the yellowish-stained brain(basal ganglia)

yellowish-stained basal ganglia

MRI shows hyperintense basal ganglia

             In my NICU round today, my friends and I encountered a case that profoundly touched our hearts. The baby presented to us with Kernicterus. He was a home-birth delivery baby. His mother came to hospital after 5 days of delivery complaining that her baby refused to feed. And the baby at that time was lethargic with very ill-looking. The baby was diagnosed with ABO hemolytic disease of newborn. It occurs when the mother with blood group O, pregnant to a baby with different blood group. So the mother will produce IgG antibody that pass through the placenta, and begins to attack the fetal RBC. The RBC hemolysed, and start to give out bilirubin resulting in hyperbilirubinemia. But this condition, if managed properly does not bring the child to Kernicterus. Simply the management is phototherapy and if the bilirubin level is so high, blood transfusion is indicated.

             Due to failure of the mother to bring the baby earlier to the hospital, the baby suffered permanent mental retardation with loss of hearing. The baby was born normal, became mentally retarded due to his mother mistake and ignorance.

a boy suffering with Kernicterus

             In developed countries, Kernicterus is rarely happen. My NICU professor said that recent conference he attended came with idea to eradicate Kernicterus, and he bravely said that this is hardly to happen in Egypt. This may be due to ignorance and low mentality of some mothers about the importance of antenatal checkup and giving birth in hospital.

So lessons that we get by this story are: 

1.       Knowledge can save lives.

2.       The importance of antenatal check up in pregnant woman.

3.       Every human has his/her own destiny and fate.

4.       Allah is The-all Just.