Recurrence of kernicterus in term and near‐term infants in Denmark

Abstract

Classical acute bilirubin encephalopathy (kernicterus) in term and near‐term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A‐O blood type immunization, and unknown in two infants. However, one of these last‐mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531–745 μmol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so‐called breastfeeding‐associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near‐term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content. Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near‐term, who develop a plasma bilirubin concentration above the exchange transfusion limit.

Incidence and causes of severe neonatal hyperbilirubinemia in Canada

“…Cases of kernicterus continue to be reported worldwide. 4,10,28 Although our study was not designed to assess the incidence of long-term neurologic disease (e.g., kernicterus), a further systematic study estimating the incidence of kernicterus in Canada and its associated morbidity would be valuable. A major limitation of the study was the reliance on self-reported data.…”

Severe Neonatal Hyperbilirubinemia in the Netherlands

“…In the 1990s, a recurrence of cases of bilirubin encephalopathy was reported, though recent data suggest that kernicterus never really disappeared [7,8,9,10]. This supposed recurrence, or persistence of bilirubin encephalopathy, is attributed to changing demographics, diminishing clinical experience and increasing nonhospitalized perinatal care.…”

Predicting Nonhemolytic Neonatal Hyperbilirubinemia

“…Although not the aim of this study, we note with great concern that our crudely estimated incidence is high compared with estimates of kernicterus in term infants reported previously. 7,14,39 Our observation warrants additional validation of the kernicterus diagnosis in the Swedish Medical Birth Register and more information on background, clinical course, and outcome in these patients.…”

“…3,4 High levels of unconjugated bilirubin could be associated with brain dysfunction and even permanent brain damage, known as kernicterus. 5,6 In light of the recurrence of kernicterus in healthy term infants, [7][8][9] prediction and early detection of infants at risk have received high priority. Different guidelines and approaches [8][9][10][11][12][13][14][15][16] have been issued, among which that of the American Academy of Pediatrics (AAP) 17 is the most commonly used worldwide.…”