Many parents know how complex a baby’s first few weeks of life can be. Most infants receive a series of tests when they’re born, and one of the most important tests searches for a life-threatening condition called kernicterus.

As an extreme form of untreated jaundice, kernicterus can lead to brain damage or even death without immediate medical attention. This article shows how to recognize the symptoms of jaundice and kernicterus, answering questions like:

• What is jaundice?
• What is kernicterus?
• What are the early signs and symptoms of jaundice and kernicterus?
• What are the stages of kernicterus?
• What are the risk factors for jaundice and kernicterus?
• What are the treatment options for kernicterus?
• What causes yellow skin other than jaundice?
• Where can I find help for kernicterus?

What is jaundice?

Jaundice occurs when the liver fails to remove a waste product called bilirubin. Jaundice can affect both children and adults, but it’s especially common in newborns—60-80% of babies in the United States will develop jaundice in their first few weeks of life. will develop jaundice in their first few weeks of life.

Bilirubin is a yellowish pigment created during the breakdown of red blood cells. Too much bilirubin in a baby’s blood results in yellow or orange skin, difficulty sleeping and eating, and other symptoms beyond having a “fussy” newborn.

During pregnancy, the mother’s liver removes bilirubin for the baby. After birth, the baby’s liver must remove the bilirubin. It is normal for newborns to have high bilirubin levels and yellowing eyes, but most babies’ livers can pick up the slack after a few days.

If the baby’s liver does not remove the bilirubin, jaundice sets in.

What is kernicterus?

Kernicterus is a rare and preventable kind of brain damage that can happen in newborns with very high levels of bilirubin in their blood. Without immediate medical attention, kernicterus can result in permanent disability or, in extremely rare cares, death.

Among other disabilities, kernicterus can cause:

• Athetoid cerebral palsy 
• Hearing loss
• Vision problems
• Dental issues
• Delayed or unusual motor development and movement
• Intellectual disabilities
• Seizures

What are the early signs and symptoms of jaundice and kernicterus?

Parents should see a doctor immediately if they notice signs of jaundice in their child. Symptoms of jaundice are most noticeable in the eyes and skin, one of the most obvious being slightly yellow eyes.

Jaundice symptoms might include:

• Yellow eyes (e.g. whites of eyes turning yellow, yellow in the corner of the eyes)
• Yellow or orange skin
• Dark urine and pale stools
• Itchiness
• Fatigue
• Vomiting
• Fever
• Abdominal pain

Jaundice symptoms in babies might also include:

• Yellow or orange skin that appears first in the head, then the rest of the body
• Problems feeding, both with breastfeeding and bottle feeding
• Fewer wet or dirty diapers
• Difficulty falling asleep or waking up
• Extreme fussiness

In addition to jaundice, symptoms of kernicterus in babies include: 

• High-pitched and inconsolable crying
• Decreased appetite
• Floppy or limp body
• Uncontrollable movements or seizures
• Vomiting
• Lack of wet or dirty diapers
• Fever
• An arched or bowed body (head and heels leaned back, stomach extended forward)

What are the stages of kernicterus?

There are three stages of kernicterus.

• The early stage of kernicterus includes difficulty feeding and suckling. The baby will be very sleepy and have low muscle tone. They likely will not respond to loud noise.
• In the middle stage, the baby may become irritable and have a high-pitched cry and tense muscles.
• In the late stage of kernicterus, the baby has no interest in feeding, stiff muscles, and seizures. Late-stage kernicterus is life-threatening.

What are the risk factors for jaundice and kernicterus?

Because jaundice is so common in newborns, there are many risk factors: 

• Preterm babies born before 37 weeks of pregnancy might have jaundice because their liver is not fully developed.
• Jaundice may be missed or not recognized in a baby with a darker skin color. 
• Babies born with East Asian or Mediterranean descent are at a higher risk of becoming jaundiced. 
• Babies who are not eating or going to the bathroom well in the first few days of life are more likely to get jaundiced.
• If an older sibling had jaundice, younger siblings are more likely to develop it.
• A baby with bruises at birth is more likely to get jaundice. 
• Women with blood type O or who are Rh-negative are more likely to have a baby with jaundice. 

What are the treatment options for kernicterus?

The goal of treatment in kernicterus cases is to cure the underlying jaundice. Treatments include:

• Increasing breast milk or formula to help the system rid itself of the yellow pigment through urine and stool. 
• Phototherapy (light therapy) involves using a special blue light on the baby’s skin in the hospital or at home to break down bilirubin. 
• Fluids are critical, especially when a baby receives phototherapy. If the baby isn’t drinking or is severely dehydrated, they may need IV fluids.
• If a baby shows signs of brain damage from kernicterus, doctors may order a blood transfusion to lower bilirubin levels as quickly as possible. A blood transfusion may be necessary if the baby does not respond to other treatments.

What causes yellow skin other than jaundice?

Jaundice causes a yellowing discoloration of the eyes as well as the skin. However, jaundice is not the only condition with these symptoms. Yellow skin or eyes can also be caused by:

• Diet. If the scleras of the eyes are still white, but the skin is yellow, diet may be the problem. Too many foods rich in carotene, like carrots, sweet potatoes, and peaches, can cause a condition called carotenemia. Carotenemia's primary symptom is yellow skin, and may go away with dietary changes.
• Diabetes. This includes prediabetes, gestational diabetes, and Type 1/Type 2 diabetes.
• Hypothyroidism. When the thyroid gland under-produces hormones, it can cause yellow skin as well as physical and mental health changes.

If you have concerns about skin discoloration, talk to your pediatrician or family doctor right away.

Where can I find help for kernicterus?

Your pediatrician is the primary resource for jaundice and kernicterus treatments. In addition, Ability Central offers a searchable database of nonprofits that can help with the long-term effects of kernicterus-associated brain damage.

To learn more about conditions related to or caused by kernicterus, see:

• Cerebral Palsy: What to do after receiving a diagnosis
• Deafness, Types of Hearing Loss, and What Causes Each
• What is Epilepsy? Common Questions, Causes, and Treatments