Kernicterus brain injury claims

If your baby has cerebral palsy or neurological disability, which was caused by jaundice soon after their birth, they may have suffered a kernicterus brain injury.

Jaundice is common and often harmless for newborn babies but severe jaundice can be dangerous if untreated. Your midwife or doctor must recognise and respond to signs or concerns that your baby has jaundice and take steps to safeguard them from more serious injury. Mistakes and delays in diagnosis, monitoring and treatment of neonatal jaundice can lead to kernicterus, with lifelong, severe disability including difficulties with vision, hearing, learning and communication, and cerebral palsy. Kernicterus is preventable with correct neonatal care.  Where kernicterus injury occurs, it is commonly caused by medical negligence. 

On this page, you will find the answers to many of the questions that families have about neonatal brain injury from kernicterus: what it is, how it happens and when you should seek help.

Our neonatal brain injury solicitors have helped countless families of injured children to understand how their injury occurred and to claim the compensation and support that they need for their child. We can help you answer these questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s kernicterus brain injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced kernicterus brain injury claims solicitors.

What is kernicterus?

Kernicterus is a dangerous but preventable complication of neonatal jaundice. It occurs when severe jaundice is left untreated, allowing high levels of bilirubin to cause damage to the newborn baby’s brain.

Bilirubin is a yellow substance that our bodies produce when our red blood cells break down. This is a natural process and most people’s bilirubin is then processed by their liver and passed from their body as waste. 

A newborn baby’s liver may still be undeveloped and unable to remove their bilirubin from their blood. Too much bilirubin in the blood (or hyperbilirubinaemia) causes jaundice, which is often evident as yellow discolouration of the baby’s skin or the sclera (the white of their eyes).

Mild jaundice is common in newborn babies and often resolves on its own. However, if your baby has signs of jaundice, this must be recognised and your midwife or doctor must monitor your baby’s condition and ensure that their bilirubin remains within safe levels. If your baby’s hyperbilirubinaemia persists or is likely to exceed safe threshold levels, they should be treated with phototherapy and/or an exchange transfusion.  This is because unprocessed (or unconjugated) bilirubin can be toxic to the brain and spinal cord.   

If hyperbilirubinaemia remains untreated, unprocessed bilirubin in your baby’s bloodstream can pass through the blood-brain barrier, causing irreversible damage to the brain and spinal cord. This causes neurological disability, such as cerebral palsy.  This type of injury is known as bilirubin encephalopathy. The pattern of damage and  its characteristic yellow staining of the brain is known as kernicterus. Brain injury from kernicterus is avoidable with correct care, but once the kernicterus brain injury occurs it is permanent and cannot be treated.

Which babies are at risk of kernicterus?

All newborn babies are at risk of developing neonatal jaundice, but even for those babies at increased risk, kernicterus is preventable with correct neonatal care, including early diagnosis, careful monitoring and timely treatment.  

The risk of kernicterus is increased where the baby:

• is born prematurely;
• develops jaundice within the first 24 hours of life;
• is solely breast-fed;
• is born at full term and has too much bilirubin in their blood (hyperbilirubinaemia);
• has bilirubin levels above the recommended treatment threshold which are rising rapidly;
• has a sibling who has had hyperbilirubinaemia.

An investigation by HSIB found that babies with darker skin colour also have an increased risk of neonatal jaundice being missed when visual inspection for signs of jaundice focusses primarily on yellow discolouration of the (assumed White) baby’s skin.

What is neonatal jaundice?

Jaundice is a very common condition which affects 60% of full-term babies and 80% of premature babies in their first week of life. It is often harmless and most babies’ jaundice resolves naturally within two weeks.

If your baby has jaundice, this may appear as yellow discolouration of their skin and whites of their eyes, and their nappy will show dark staining of their urine and paleness of their stools. The yellow discolouration is caused by an excess of a yellow, natural pigment called bilirubin, which is released into the bloodstream during the body’s normal process of breaking down old red blood cells. Bilirubin is processed by the liver and travels in the bloodstream to the bile duct and gallbladder where it is stored and safely used, as bile, to help digest fats in the small intestine. It is then passed from the body as waste. Newborn babies become jaundiced when their undeveloped liver struggles to process their bilirubin, leaving them with too much bilirubin in their blood (hyperbilirubinaemia). If your baby has too much bilirubin in their bloodstream, this causes the yellow discolouration of their skin and whites of their eyes.

Neonatal jaundice can be harmless but can also become dangerous if the baby’s bilirubin levels become too high, so any signs of jaundice must be recognised, monitored and treated where needed to avoid permanent brain injury from kernicterus.

Jaundice can also be a sign of other serious health conditions which may be affecting the functioning of the baby’s liver. These conditions include:

• liver disease;
• infection or sepsis;
• Rhesus disease, (incompatibility between the mother’s and baby’s blood groups);
• bruising and metabolic disorders;
• sickle cell anaemia;
• enzyme deficiencies.

What is the treatment for neonatal jaundice?

Mild neonatal jaundice often resolves without treatment, but it is vital that your baby’s jaundice is diagnosed and monitored to ensure that the bilirubin in their blood remains at safe levels. If your baby’s jaundice persists or if their hyperbilirubinaemia is increasing rapidly and is likely to exceed threshold levels, they should be treated with a special light treatment known as phototherapy. In some cases, an exchange transfusion may be needed to safely remove the excess bilirubin from your baby’s blood.

Can medical negligence cause kernicterus brain injury?

Kernicterus brain injury is preventable with correct detection, monitoring and treatment of neonatal jaundice. Kernicterus should not occur if a newborn baby has received proper neonatal care. Negligent delays and mistakes in the diagnosis, monitoring and treatment of jaundice can lead to kernicterus brain injury and are a common cause of neonatal brain injury and cerebral palsy claims against hospitals, GPs and community midwives.

If your baby has a diagnosis of kernicterus brain injury, we recommend you contact us for free, confidential advice from our specialist kernicterus injury solicitors. If your baby’s kernicterus was caused by medical negligence they may be entitled to substantial compensation.

Our solicitors’ experience of helping families with successful kernicterus brain injury claims includes:

• a $23 million settlement for a boy who is severely disabled by kernicterus brain injury, cerebral palsy, visual impairment and profound deafness, after postnatal community midwives failed to recognise and treat his neonatal jaundice;
• a £7 million settlement for a child who suffered a kernicterus brain injury and severe neurological disability from cerebral palsy as a result of delayed referral to hospital for treatment for jaundice;
• a compensation settlement for a premature baby who suffered kernicterus brain injury after delays in phototherapy treatment for neonatal jaundice.  

Medical negligence claims arising from kernicterus brain injury often involve one or more of the following mistakes:

• failure to examine or observe a newborn baby for signs of jaundice;
• inadequate visual examination for signs of jaundice in a darker skinned baby;
• delayed diagnosis or failure to recognise signs of neonatal jaundice;
• delay or failure in referring or admitting the baby to hospital;
• monitoring failures;
• failure to check the baby’s bilirubin levels;
• delayed or inadequate treatment for hyperbilirubinaemia;
• failure to follow national guidelines or hospital protocols;
• failure to provide safety-netting advice to the baby’s parents;
• failing to respond to parental concerns about changes in skin colour and other potential signs of jaundice.

What are the effects of kernicterus brain injury?

Kernicterus causes irreversible damage to the baby’s brain, which results in life-changing, severe disability.

A baby who is becoming seriously unwell from neurological injury may not feed properly or respond to stimulus in the usual way. Their muscle tone may become floppy, and they may start to have seizures (fits) or they arch their spine.

Permanent kernicterus brain injury causes long-term disability, such as:

• cerebral palsy;
• learning disability;
• hearing loss;
• visual impairment;
• impaired dentition (dental enamel hypoplasia or dysplasia).

We understand the devastating impact that a kernicterus brain injury can have on your child and your family. A kernicterus medical negligence claim cannot reverse your child’s injury, but the compensation it provides can help you meet their additional needs for care, a suitable home, support with special educational needs (SEN), therapies and specialist equipment, as well as providing them with long-term financial security.   

Read more about how we help our severely disabled clients with compensation.