Invited CommentarySystem-based approach to management of neonatal jaundice and prevention of kernicterus☆,☆☆,★
Section snippets
Pilot kernicterus registry for term and near-term infants
In response to reports of kernicterus in term and near-term infants discharged as healthy from their place of birth,8 we inaugurated a Pilot Kernicterus Registry in May of 1992. Additional reports of kernicterus have appeared in the literature since that time.9, 10, 11 We have compiled these cases, together with cases directly contributed by colleagues or identified through medical-legal consultations, into a voluntarily reported kernicterus registry database. Cases were evaluated for
Overview of the database
Readmission age, as well as total serum bilirubin (TSB) level and details of treatment, were available in 80 of the 90 infants enrolled in the registry. In these 80 infants, age at readmission and/or medical intervention ranged from 2.5 days to 15 days. In 61 infants (76%), readmission was by 7 days of age. Of the 90 infants, 3 died and 6 were lost to follow-up before 1 year of age. Of the 81 infants with follow-up (through 18 months of age) 75 (93%) had classic kernicteric sequelae, whereas 6
Comments
This review of 90 cases in the Pilot Registry, as of January 1, 2001, confirms the neurotoxic potential of bilirubin and the occurrence of kernicterus in term and near-term infants discharged as healthy from well-baby nurseries in the United States. On the basis of these data, health care practitioners and parents can no longer be reassured that the risk of kernicterus in “healthy” term and near-term newborns is so highly remote as to be of little concern.4, 5, 6, 7 Misunderstanding was evident
Conclusions
Kernicterus is a tragic and unacceptable outcome for an otherwise healthy newborn in the United States. The infrequency of its occurrence within a small subset of high-risk infants (with TSB/TcB levels ≥95th percentile for age in hours) complicates effective prevention of kernicterus in the population at large. There is a clear need for (1) increased awareness of the problems inherent in the management of neonatal jaundice, especially as associated with early hospital discharge and medical care
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Pediatrics
Diagnosis of kernicterus in the neonatal period
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Bilirubin and brain injury
BIND-a clinical score for bilirubin induced neurologic dysfunction in newborns
Pediatrics Supplement
Cited by (0)
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†Deceased.
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Reprint requests: Lois H. Johnson, MD, FAAP, 800 Spruce St, Philadelphia, PA 19107.
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J Pediatr 2002;140:396-403.