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Kapi`olani Uses New Screening Test to Prevent Newborn Brain Damage Stephen Yano, M.D. The latest addition to Kapi`olani’s regimen of newborn screening tests helps pediatricians prevent irreparable brain damage. Following the recommendations of the American Academy of Pediatrics, Kapi`olani implemented this screening test last year. It detects severe jaundice that can lead to kernicterus, a condition that can cause lifelong brain and physical impairment. “Jaundice is caused by a buildup of a pigment called bilirubin,” says Stephen Yano, M.D., pediatrician at Kapi`olani. During pregnancy, bilirubin is processed by the mother’s liver and is flushed out of the body. Following delivery, the infant’s liver needs to “wake up” or begin functioning. The buildup of bilirubin turns the baby’s skin and the whites of the eyes yellow. “Kernicterus results from staining of parts of the newborn brain and, if it occurs, can result in a 10 percent fatality rate and a 70 percent chance of poor brain development or seizures in those who survive,” says Dr. Yano. Kapi`olani Medical Center for Women & Children is the first in the state to offer the screening for all newborns. The simple test uses a meter on the baby’s skin to measure levels of jaundice. “The presence of mild jaundice is ‘normal’, however, severe jaundice can be life threatening or can cause brain damage,” Dr. Yano explains. Signs of severe jaundice may include a deep yellow color to the skin, poor feeding, lethargy, a high-pitched cry, increased stiffening and at the worst, seizures. New technology helps detect jaundice The “BiliCheck” monitor is the newest device used to monitor jaundice. Daily measurements make the pediatrician aware of rapidly rising values. Blood tests confirm the condition so early treatment can be started to prevent the potential damaging effects of severe jaundice. Early treatment can prevent the complications of jaundice. Light energy, in the form of phototherapy lights, helps control the rise of bilirubin and allows time for the infant’s liver to begin detoxifying the pigment (bilirubin). “The most important thing for the safety of your newborn is that you recognize the warning signs of jaundice. Follow up with your physician two to three days after returning home from the hospital. Call sooner if you see signs of severe jaundice developing in your infant,” says Dr. Yano. “With this new screening test for severe jaundice, Kapi`olani’s nursery is a safer place for our young infants.” Danger Signs in a Newborn Yellow discoloration that usually starts in the face, then progresses to the chest. Jaundice may then spread to the stomach and legs. Examine your baby carefully in natural daylight or in a room with florescent lights. If your infant has already been diagnosed with jaundice, call the doctor immediately if the baby’s skin color becomes more yellow, if jaundice spreads to the abdomen, arms or legs, or if the whites of the baby’s eyes become yellow. Most babies have no other symptoms. However, parents should call the doctor immediately or seek emergency care if baby develops increased sleepiness or is hard to wake, sucks or nurses poorly, appears weak or floppy, arches the neck or back backward, or develops a high-pitched cry or fever. These may be early warning signs of dangerously high levels of bilirubin.