Kernicterus in newborns: A preventable birth injury with life-changing consequences

It can be prevented by early monitoring for jaundice, ensuring adequate feeding, particularly in breastfed babies and timely treatment for hyperbilirubinemia. 

Despite advances in neonatal care, kernicterus continues to occur—often because of missed clinical opportunities to treat the cause quickly. These missed opportunities often result in a child developing cerebral palsy and needing life-long care and support.

It is estimated (HSSIB report) that 1 in 20 babies have bilirubin levels high enough to need treatment.

A baby will be examined for signs of jaundice within 72 hours of birth by NHS staff as part of the ‘newborn and infant physical examination’ (NIPE). Babies with black or brown skin are identified as more at risk since visual signs of jaundice may be more difficult to identify.

A report by the NHS Race and Health Observatory found that Asian babies ‘were overrepresented in admissions to neonatal units for jaundice’. The report also noted that previous research has questioned whether some babies could have been ‘identified earlier’ and that ‘visual estimation of jaundice in babies is highly inaccurate’.

The British Association of Dermatologists (BAD) wants to improve descriptions of clinically significant signs across different skin tones and to address the lack of diversity in information about skin conditions.

Fieldfisher's medical negligence team is expert in advising parents when they might have a claim and offers ongoing support to families affected by this preventable condition. We pride ourselves on holding healthcare providers accountable when standards of care fall short and ensuring that a child living with a severe brain injury receives the appropriate care for life.

Read Iona's recent case involving kernicterus here.

What Is Kernicterus?

Kernicterus is a serious condition caused by high levels of circulating unconjugated bilirubin, which can enter the brain and act as a neurotoxin.  Jaundice, characterised by a yellow discolouration of the skin and the whites of the eyes, results from elevated bilirubin levels. Neonatal jaundice is relatively common and is a significant clinical condition in newborns. Bilirubin levels can be reduced through phototherapy, a simple treatment that converts bilirubin in the skin to lumirubin, which is then excreted. If bilirubin levels cannot be controlled with phototherapy, an exchange transfusion may be necessary.

The NICE guideline on Jaundice clearly states that it is not possible to accurately assess bilirubin levels through clinical assessment alone (“eyeballing”). Therefore, bilirubin should be measured whenever jaundice is suspected, regardless of who observes it, including family members.

If not treated promptly, bilirubin can cross the blood-brain barrier and cause permanent damage to areas of the brain responsible for movement, hearing, and cognition. The result can be life-altering: cerebral palsy, hearing loss, visual impairment, and severe developmental delays.

Why Is It So Dangerous?

The tragedy of kernicterus lies in its preventability. Jaundice is common in newborns and usually harmless. But when clinicians fail to monitor bilirubin levels, delay treatment, or discharge babies too early without proper follow-up, the consequences can be catastrophic.

Clinical Failures and Legal Implications

Kernicterus cases often involve clear elements of medical negligence, including:

• Failure to adequately advise parents of signs and symptoms
• Failure to perform timely bilirubin testing
• Inadequate monitoring of jaundice progression
• Misinterpretation of test results
• Early discharge without follow-up
• Dismissal of parental concerns

How We Help Our Clients

We are expert in pursuing birth injury claims involving kernicterus and always provide comprehensive legal and emotional support to families affected by this type of birth injury. Once instructed, the process includes:

• Obtaining medical records
• Involving independent medical experts to establish breach of duty and causation
• Involving further experts to assess the particular condition of your child to properly understand their needs
• Securing interim payments for urgent care, medical and therapeutic needs
• Long-term financial planning for therapy, education, and support

We understand the emotional toll these cases cause and are committed to helping families secure justice and financial stability to help the whole family live their best possible lives.

New Research and Policy Developments

The National Institute for Health and Care Excellence (NICE) recommends universal bilirubin screening for at-risk infants, but uptake varies. A 2025 policy review noted that while kernicterus is rare, the high prevalence of neonatal jaundice means many babies must be treated to prevent a single case—highlighting the need for better risk stratification and consistent care protocols.

The continued presence of kernicterus in the UK is a reminder of what can happen when early warning signs are missed.

Fieldfisher's medical negligence team is committed to supporting families, raising awareness, and driving improvements in clinical practice. Where settlement is achieved for a child lacking capacity, our Court of Protection team regularly acts as deputy and manages financial affairs.