Jaundice & Kernicterus
Jaundice is the yellow color seen in the skin of many newborns. Jaundice results when a chemical called bilirubin builds up in the baby’s blood. Too much bilirubin can cause hyperbilirubinemia. It is the most frequent reason for hospital readmission during the first week of a baby’s life.
Jaundice can develop when red blood cells break down and bilirubin is left. It is normal for some red blood cells to die every day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. Your baby’s doctor or nurse can test how much bilirubin is in your baby’s blood.
Kernicterus is a type of brain damage that causes athetoid cerebral palsy and hearing loss. It also causes problems with vision and teeth and sometimes can cause mental retardation.
Any baby with untreated jaundice is at risk for kernicterus. This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need phototherapy treatment. If phototherapy does not lower the baby's bilirubin levels, the baby may need an exchange transfusion.
Warning signs of Kernicterus:
Ask your pediatrician to see your baby the day you call, if your baby:
*Is very yellow or orange (skin color changes start from the head and spread to the toes)
*Is hard to wake up or will not sleep at all
*Is not breastfeeding or sucking from a bottle well
*Is very fussyDoes not have at least 4 wet or dirty diapers in 24 hours
Sudden Unexpected Infant Death (SUID)
Sudden unexpected infant deaths are defined as infant deaths that occur suddenly and unexpectedly, and whose manner and cause of death are not immediately obvious prior to investigation.
Each year in the United States, more than 4,500 infants die suddenly of no obvious cause. Half of these Sudden Unexpected Infant Deaths (SUID) are due to Sudden Infant Death Syndrome (SIDS), the leading cause of SUID and of all deaths among infants aged 1–12 months.
Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history.
SIDS is the leading cause of death among infants aged 1–12 months, and is the third leading cause overall of infant mortality in the United States. Although the overall rate of SIDS in the United States has declined by more than 50% since 1990, rates have declined less among non-Hispanic Black and American Indian/Alaska Native infants. Preventing SIDS remains an important public health priority.
For a medical examiner or coroner to determine the cause of the death, an investigator needs to conduct a thorough investigation including examination of the death scene and a review of the infant’s clinical history. A complete autopsy needs to be performed, ideally using information the investigator has gathered. Even when a thorough investigation is conducted, it may be difficult to separate SIDS from other types of sudden unexpected infant deaths, especially accidental suffocation in bed.
After a thorough death scene investigation, review of medical records and a complete autopsy, many of these sudden unexpected infant deaths may be explained. Poisoning, metabolic disorders, hyper or hypothermia, neglect and homicide, and suffocation are all explainable causes of SUID. SIDS and cause unknown are examples of those that remain unexplained SUID.