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kernicterus; neonatal jaundice; neonatal hyperbilirubinemia
Etiology:
1) hemolysis
- Rh disease
2) polycythemia
3) pyloric stenosis
4) congenital hypothyroidism
Pathology:
1) inefficient uptake of bilirubin by immature hepatocytes predisposes to hyperbilirubinemia
2) kernicterus is due to accumulation & deposition of bilirubin in the brain
Clinical manifestations:
- usually develops in 1st week of life
- early
- jaundice
- absent startle reflex
- poor feeding or sucking
- lethargy
- mid-stage:
- high-pitched cry
- arched back with neck hyperextended backwards
- bulging fontanel
- seizures
- late
- high-frequency hearing loss
- mental retardation
- muscle rigidity
- movement disorder
Laboratory:
- serum bilirubin > 20-25 mg/dL
Complications:
- permanent brain damage
- cerebral palsy
- hearing loss
- death
Management:
- phototherapy with blue light (420-470 nm)
- soft eye shields are used to prevent retinopathy [3]
- exchange transfusions as indicated
General
metabolic brain disease
neonatal jaundice
References
- PubMedHealth: Kernicterus
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004562/
- Springer SC
eMedicine (Medscape): Kernicterus
http://emedicine.medscape.com/article/975276-overview
- Wikipedia: Bili light
http://en.wikipedia.org/wiki/Bili_light