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Kernicterus

more about Kernicterus


Bilirubin encephalopathy, excess bilirubin



  • This is a neurological syndrome caused by deposition of unconjugated bilirubin in the brain cells.
  • It is rare in healthy full-term infants.
  • It usually occurs several days after birth.

  • Early phase:
    1. Loss of the Moro's (startle) reflex
    2. Poor feeding
    3. Lack of energy
    4. Decreased activity
  • Later phase:
    1. A high-pitched shrill cry
    2. Unusual posturing
    3. A bulging fontanel
    4. Seizures
    5. Decreased muscle tone
    6. Movement disorders
    7. High-pitched hearing loss
    8. Decreased mental ability

  • It is caused by high blood levels of the pigment bilirubin deposited in the brain cells, resulting in damage
  • It develops in extremely jaundiced infants, especially those with severe Rh incompatibility.

  • Based on clinical findings
  • Elevated serum bilirubin level

  • Premature birth
  • Severe hemolytic disease with high serum bilirubin level (greater than 20 mg/dL)

  • Phototherapy
  • Blood exchange transfusion
    1. Rh O type for Rh incompatibility
    2. Same blood type to infant for ABO incompatibility
  • Medication: Phenobarbital

  • Later in the 1st year:
    1. Abnormal position: head and heels are bent backward and the body is bowed forward.
    2. Muscular rigidity
    3. Irregular movements
    4. Muscular rigidity
    5. Decreased muscle tone
  • By 3 years of age:
    1. Bilateral involuntary motions
    2. Seizures
    3. Mental deficiency
    4. Speech abnormality
    5. High-frequency hearing loss
    6. Squints, defective upward movement of the eye
    7. Partial deafness
    8. Cerebral Palsy

  • More than 75% of patients with neurologic symptoms die
  • More than 80% of survivors have involuntary motions

  • Contact your doctor if your child has severe jaundice, if jaundice lasts longer than 1 or 2 weeks, or if other symptoms develop.




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