Originally created 05/03/01

Hospitals alerted about brain damage linked to untreated jaundice



CHICAGO -- An increasing number of U.S. infants are developing rare but permanent brain damage caused by untreated jaundice at birth, according to the agency that regulates hospital safety.

In an alert to be issued Wednesday to the nearly 5,000 hospitals it evaluates, the Joint Commission on Accreditation of Healthcare Organizations said doctors are seeing a re-emergence of a condition called kernicterus.

"These cases are true tragedies, not only for the children, but also for the families," said Dr. Paul M. Schyve, the commission's senior vice president.

Kernicterus is not monitored by the federal Centers for Disease Control and Prevention, but an informal physicians' registry suggests that about 90 cases have occurred since 1984, said Dr. Jeffrey Maisels, who heads an American Academy of Pediatrics subcommittee that is revising 1994 guidelines for treating jaundice.

While that's a tiny portion of the estimated 4 million annual births nationwide, doctors suspect the numbers are higher.

Sending babies home soon after birth - what critics call "drive-through" deliveries - has contributed to the problem, which usually involves a severe form of cerebral palsy with poor muscle control, according to the academy.

Hearing loss, teeth malformations and other handicaps also may occur, said Maisels, who is chairman of pediatrics at William Beaumont Hospital in Royal Oak, Mich.

It is especially troubling because it's preventable, Maisels said. Kernicterus can develop in nearly any infant with jaundice, which affects more than half of all U.S. newborns, he said.

Jaundice can cause a yellowing of the skin and involves an elevated level of bilirubin, which is a naturally occurring byproduct of decomposing red blood cells.

The liver filters bilirubin from the blood, but newborns' livers typically don't start functioning fully until a few days after birth, making them prone to jaundice.

Maisels said doctors aren't certain how bilirubin damages the brain, but autopsies of infants with kernicterus have found yellow staining in a region of the brain that controls movement.

Kernicterus is believed to have been somewhat common in the 1940s and 1950s, before the development of a jaundice treatment called exchange transfusion, which replaces a newborn's blood with adult blood.

The condition had become rare by the 1970s, when newborns routinely remained in the hospital for several days after birth, Maisels said.

Simple blood tests can detect elevated bilirubin levels and are recommended by the academy for all newborns who appear jaundiced.

But obvious jaundice may not appear until several days after a newborn has been sent home, making it crucial for doctors to be aware of risk factors for jaundice, the commission said.

Jaundice may resolve by itself or with treatment that now usually involves placing the infant under special fluorescent lights that make bilirubin more easily filtered by the liver. Blood transfusions are done only in severe cases.

Babies at increased risk for jaundice include those born a few weeks prematurely, those who may be improperly nourished because of inefficient breast-feeding, and those who have siblings who experienced jaundice.

The commission's recommendations include evaluations for all newborns with jaundice, medical follow-ups for newborns within two days after they are sent home, and educating parents about jaundice and its potential risks.

On the Net:

Joint Commission: http://www.jcaho.org

American Academy of Pediatrics: http://www.aap.org