No abstract available.
Kernicterus*

No abstract available.
Bilirubin* ; Humans ; Infant, Newborn* ; Kernicterus*

No abstract available.
Bilirubin* ; Brain Stem* ; Humans ; Infant, Newborn* ; Kernicterus*

PURPOSE: Neonatal immune hemolytic jaundice due to blood group incompatibility is important to treat properly because of an early rise and a high peak of serum bilirubin level and a risk of kernicterus. The conventional therapeutic modalities for neonatal immune hemolytic jaundice due to blood group incompatibility are phototherapy and exchange transfusion. We evaluated the effect of intravenous immune globulin (IVIG) therapy on hyperbilirubinemia due to ABO incompatibility. METHODS: This study included 6 infants with hyperbilirubinemia due to ABO incompatibility who were admitted to the nursery of Eulji Medical Center, Nowon Hospital, from January 2000 to February 2001. All 6 infants had a positive direct Coombs test. Their serum bilirubin levels were above 12 mg/dl within 24hours of age and above 20 mg/dl after 24hours of age. They were treated with intensive phototherapy and IVIG. RESULTS: We classified the effective group when a decline in serum bilirubin level was more than 2 mg/dl in 3-4 hours after IVIG therapy, and the ineffective group when there was a decline in serum bilirubin level less than 2 mg/dl, a re-rise after the initial response to IVIG, or a decline after the combined therapy with intensive phototherapy and IVIG equal or less than that after intensive phototherapy alone. In the effective group (n=2), the average decline in serum bilirebin level was 4.1 mg/dl in 3-4 hours and 8.1 mg/dl in 12-16 hours after IVIG therapy, while in the ineffective group (n=4), the average decline was 1.9 mg/dl and 2.7 mg/dl, respectively. Five among 6 infants were treated with IVIG therapy and 1 infant was treated with exchange transfusion. No serious side effect was detected during and after IVIG therapy. CONCLUSION: We demonstrated the effectiveness of IVIG therapy in 2 infants out of six who were treated with intensive phototherapy and IVIG for hyperbilirubinemia due to ABO incompatibility. IVIG therapy could be considered if hyperbilirubinemia due to ABO incompatibility does not respond to intensive phototherapy alone. Further prospective and randomized studies would be needed.
Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Humans ; Hyperbilirubinemia ; Immunoglobulins, Intravenous* ; Infant ; Jaundice* ; Kernicterus ; Nurseries ; Phototherapy

PURPOSE: We sought to quantitate the cytotoxicity of bilirubin for neuronal cells at various concentrations of bilirubin and at various [bilirubin]/[albumin] ratio. METHODS: Mouse cerebral cortical cells were obtained from 15 day-old mouse fetal cerebral cortex primary culture. Cerebral cortical cells were exposed to medium containing various concentrations of bilirubin and [bilirubin]/[albumin] ratios for 4 hours. Then, the bilirubin cytotoxicity for cerebral cortical cells was quantitated by the activity of lactate dehydrogenase (LDH) released from cerebral cortical cells into the culture media and the viability of cerebral cortical cells was quantitated by MTT (3-[4, 5 dimethylthiazol-y-yl]-2, 5-diphenyl tetrazolium bromide) activity measured 4 hours after the addition of MTT labeling reagent to the cell compartment. RESULTS: At a constant [bilirubin]/[albumin] ratio of 3: 1, the increasing concentration of bilirubin (50microM, 75microM, 100microM, 150microM) resulted in proportionally increased cytotoxicity (18+/-2%, 33+/-1%, 44+/-2%, 66+/-4%, respectively). At a constant bilirubin concentration of 86microM, the increasing [bilirubin]/[albumin] ratio (1: 3, 3: 1) also resulted in proportionally increased cytotoxicity (10+/-1%, 58+/-1%, respectively) and proportionally decreased viability (83+/-1%, 65+/-2%, respectively). CONCLUSION: Not only the concentration of bilirubin, but also the [bilirubin]/[albumin] ratio may be important for the cerebral cortial cell injury by bilirubin.
Animals ; Bilirubin* ; Cell Culture Techniques* ; Cerebral Cortex ; Culture Media ; Hyperbilirubinemia ; Kernicterus ; L-Lactate Dehydrogenase ; Mice* ; Neurons

We studied the guidelines on the serum bilirubin concentration of 12mg% for the management of neonatal jaundice and compared the effectiveness of oral phenobarbital and continuous phototherapy with singularly phototherapy, in reducing neonatal hyperbilirubinemia in the 100 cases admitted to the department of pediatrics, St. Benedict Hospital from April 1977 to August 1977. The results were as follows; 1. Among the 35 full term normal newborn infants without any risk factors for kernicterus, 14 infants had serum bilirubin concentration below 12mg%. In this group, 5 infants received phototherapy (35.7%). 21 infants had serum bilirubin concentration above 12mg%. In the latter group, 5 infants received phototherapy (71.4%) 2. The mean rate of fall of serum bilirubin per day was 1.81mg% in phototherapy plus phenobarbital groups and 1.57mg% in singularly phototherapy. 3. The mean peak rate of fall of serum bilirubin was 2.28mg% per day in the third to fourth day of phototherapy and phenobarbital groups and 2.76mg% per day in the fourth to fifth day of singularly phototherapy. 4. The mean duration of phototherapy was 74 hours in phototherapy plus phenobarbital groups and 82 hours in singularly phototherapy.
Bilirubin* ; Humans ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn ; Jaundice, Neonatal* ; Kernicterus ; Pediatrics ; Phenobarbital* ; Phototherapy* ; Risk Factors

A study was made of 104cases of neonatal hyperbiliruinemia receiving blood exchange transfusion at Kwangju Christian Hospital from January 1969 to December 1975, with the following results: 1. 52 patients(50%) returned for follow-up, 9 patients(8.7%) had died, and 43 patients(41.3%) did not return. 2. Of the 52 patients returning, developmental status was studied by D.D.S.T. 43 patients(82.7%) had normal development, 8(15.4%) were retarded, and 1(1.9%) was questionable. No patients had a failing score. Most of the retarded patients had cerebral palsy, due to kernicterus. 3. There was no retardation among patients exchange-transfused at age of less than 5days, or over 8 days(except 1 pts.) , and with less than 30mg% of Pre-B.E.T. serum bilirubin level. 4. No significant difference of sex incidence was noted. 5. ABO incompatibility (57%) was predominant as the etiology and main cause of retarded development (19.4%), but the idiopathic type of hyperbilirubinemia(41.3%) was interestingly high among these B.E.T. patients. 6. Mean value and standard error of pre-B.E.T. serum bilirubin levels are as follows: Normal development group:30.80+/-1.60 Retarded development group:38.83+/-2.35 The difference of men values between both groups is very significant according to the t-test. 7. Motor disturbance was the predominant handicap in retarded patients at ages less than 3 years, and after this there was a tendency toward recovery, accompanied by mild speech disturbance. Hearing loss, especially of high pitched tone, was noted in 1 patient and confirmed by audiometry.
Audiometry ; Bilirubin ; Cerebral Palsy ; Follow-Up Studies* ; Gwangju ; Hearing Loss ; Humans ; Hyperbilirubinemia* ; Incidence ; Kernicterus ; Male

Cerebral palsy (CP) usually arises in the prenatal period, interferes with normal development of the brain and presents as a disorder of motor dysfunction. It is a common cause of severe neurologic disability in children with incidence of 2 per 1000 live births in Canada. Presently, with the persistent increase in premature births and improved care in the perinatal period, the incidence of CP is strikingly augmented. According to neurologically impaired motor ability, they commonly have feeding difficulties, like swallowing, leading to frequent aspiration pneumonia and gastroesophageal reflux. Therefore, improvement of feeding techniques should be an urgent requirement to correct the risk of poor growth. We report a case of CP due to kernicterus who have recurrent pneumonia and growth failure, experience a jejunostomy to overcome the feeding problems.
Brain ; Canada ; Cerebral Palsy* ; Child ; Deglutition ; Gastroesophageal Reflux ; Humans ; Incidence ; Jejunostomy* ; Kernicterus ; Live Birth ; Pneumonia ; Pneumonia, Aspiration* ; Premature Birth

Kernicterus is a neurologic syndrome, resulting from the preferential deposition of unconjugated bilirubin in the globus pallidus, subthalamus, hippocampus, and brain stem. The characteristic finding of kernicterus revealed by T2-weighted MR imaging is irreversible, bilaterally symmetrical high signal intensities in the globus pallidus. We report an atypical case of kernicterus, in which follow-up MR imaging of the globus pallidus demonstrated reversible signal intensity.
Bilirubin ; Brain Stem ; Follow-Up Studies ; Globus Pallidus ; Hippocampus ; Humans ; Infant, Newborn ; Kernicterus* ; Magnetic Resonance Imaging* ; Subthalamus

PURPOSE: Cerebral palsy or hearing disability of hyperbilirubinemic complication was reduced by blood exchange transfusion(BET) and phototherapy(PT). But in spite of these treatment, abnormal Auditory Brainstem evoked Response(ABR) finding after BET or PT and neurodevelopmental defect due to chronic bilirubin encephalopathy were observed. So we have studied risk factors and outcome of chronic bilirubin encephalopathy after BET, and treatment of hyperbilirubinemia. METHODS: We have analyzed clinical characteristics, the finding and change of ABR after BET in 17 hyperbilirubinemic neonates, and in 8 hyperbilirubinemic neonates who were treated by phototherapy and 15 normal control neonates. RESULTS: 1) Mean bilirubin concentraion were 27.5+/-4.1mg/dL in BET group and 22.1+/-2.3 mg/dL in PT group. There were no difference of clinical findings between BET and PT group. 2) Change of ABR (1) Wave I loss resulted in 4 neonates, wave III loss in 3 neonates, and wave V loss in 2 neonates in BET group(P<0.05). (2) Wave I peak latency and hearing threshold in BET group were significantly increased more than normal control group(P<0.01). 3) In 10 neonates(58.8%) among 17 BET group, 4 neonates(50%) in 8 PT group were observed abnormal initial ABR finding after jaundice treatment. Age at treatment and duration of jaundice(interval between onset of jaundice and treatment) in abnormal ABR group were significant prolongation compared with normal ABR group(P<0.05). 4) Chronic bilirubin encephalopathy(CBE) was observed in 3 neonates(17.6%) among 17 BET group and showed higher of bilirubin level than normalized group after BET (31.1mg/dL vs 26.6mg/dL), other clinical findings showed no significant differences. CONCLUSION: Bilirubin level was significantly elevated in CBE more than in BET group and duration of jaundice, age at treatment were longer in abnormal ABR group than in normal ABR group. So not only bilirubin level but also duration of jaundice shoud be considered at jaundice treatment, and ABR has a potential utility in detection of acute brain toxicity of bilirubin and follow up evaluation of bilirubin encephalopathy.
Bilirubin ; Brain ; Brain Stem ; Cerebral Palsy ; Follow-Up Studies* ; Hearing ; Humans ; Hyperbilirubinemia ; Infant, Newborn* ; Jaundice ; Kernicterus ; Phototherapy* ; Risk Factors