Hyperbilirubinemia and Kernicterus

Posted by e-Medical PPT Friday, July 6, 2012
Hyperbilirubinemia
Most common clinical condition requiring
evaluation and treatment in the NB
Most common cause of readmission in the 1stweek
Generally a benign transitional phenomenon
May pose a direct threat of brain damage
May evolve into kernicterus

Kernicterus
Choreoathetoid cerebral palsy
2. High-frequency central neural hearing loss
3. Palsy of vertical gaze
4. Dental enamel hypoplasia (result of bilirubin-induced cell toxicity)

Originally described in NB with Rh hemolytic disease
Recently reported in healthy term and late preterm
Reported in breast-fed infants w/out hemolysis
Most prevalent risk factor is late preterm

Pathobiology
Increased bilirubin load in the hepatocyte
Decreased erythrocyte survival
Increased erythrocyte volume
Increased enterohepatic circulation
Decreased hepatic uptake from plasma
Defective bilirubin conjugation

Neuropathology of Kernicterus
Movement disorders lesions in the basal ganglia (globus pallidus/subthalamic nucleus)
Auditory dysfunction lesions of the auditory brainstem nuclei
Oculomotor impairment damage to brainstem ocular nuclei
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