Kernicterus can occur in healthy term infants. Acidosis increases movement of bilirubin into tissues and, thus, can contribute to the development of kernicterus. Although measurement of free bilirubin concentration would be useful to guide therapy, clinical testing is not universally available.ĭrugs such as sulfisoxazole, moxalactam, and ceftriaxone can displace bilirubin from albumin and increase the risk of kernicterus. High TSB concentrations may exceed the capacity of albumin to bind bilirubin and lead to higher levels of free bilirubin, which may be neurotoxic. 9 Most unconjugated bilirubin is normally bound to albumin, resulting in low levels of free bilirubin. However, the relationship between TSB and kernicterus is variable and influenced by other factors such as bilirubin affinity for albumin, which is reduced in premature and sick infants. Near-term and term infants are at risk for kernicterus when TSB concentrations exceed 25 to 30 mg/dL (428 to 513 μmol/). The regions most often affected include the basal ganglia and the brain stem nuclei for oculomotor and auditory function, accounting for the clinical features of this condition. 6– 7 Unconjugated bilirubin that is not bound to albumin (free bilirubin) can enter the brain and cause focal necrosis of the neurons and glia, resulting in bilirubin encephalopathy, which is also known as kernicterus. They include pallor, enclosed haemorrhage such as cephalhaematoma, and bruising.īilirubin is a potential neurotoxin. Physical examination may identify signs that suggest risk for pathological jaundice. 5 TSB or transcutaneous bilirubin (TcB) levels should be measured in an infant with jaundice detected below the umbilicus. The face and sclera typically appear icteric when bilirubin levels reach 6 to 8 mg/dL (103 to 137 μmol/L), whereas the entire body, including palms and soles, appears jaundiced at values of 12 to 13 mg/dL (205 to 222 μmol/L). Jaundice progresses in a cephalocaudal direction. Pressing on the skin with a finger reduces local skin perfusion and may facilitate detection of jaundice. 4 The examination should be performed with adequate ambient light. Visual inspection of skin colour can be used to detect jaundice, but it is not a reliable method to assess the level of bilirubin or identify infants at risk for rapidly rising bilirubin levels, especially in those with dark skin. They included gestational age of 35 to 37 weeks polycythaemia assisted deliveries through such methods as vacuum or forceps instrumentation trauma during labour or delivery maternal diabetes Asian race blood group incompatibility poor breastfeeding practices, or a previous sibling with jaundice. Risk factors for the development of jaundice in near-term infants were obtained from clinical histories.
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