Reemergence of Kernicterus in Fullterm Newborns

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Re-emergence of Kernicterus in Full-term Newborns
Rachel Nonkin Avchen, MS, PhD Marshalyn
Yeargin-Allsopp, MD National Center on Birth
Defects and Developmental Disabilities Karen
Carter, MD Medical College of Georgia Karen
Dixon, BS Parents of Infants and Children with
Kernicterus
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Background on Kernicterus

• Kernicterus is brain damage caused by severe and
  untreated jaundice in the newborn infant
• Any newborn with jaundice is at risk for brain
  damage
• Kernicterus should not develop in otherwise
  healthy full-term infants with jaundice

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Video permission of PICK and Pennsylvania Hospital
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Video permission of PICK and Pennsylvania
Hospital
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CDC Responds to Kernicterus Calls
June 15, 2001 / 50(23)491-4 Kernicterus in
Full-Term Infants --- United States,
1994--1998 Kernicterus is a preventable life-long
neurologic syndrome caused by severe and
untreated hyperbilirubinemia during the neonatal
period. High levels of bilirubin are toxic to the
developing newborn. In full-term infants,
hyperbilirubinemia symptoms include severe
jaundice, lethargy, and poor feeding. Features of
kernicterus may include choreoathetoid cerebral
palsy, mental retardation, sensorineural hearing
loss, and gaze paresis. Kernicterus is not a
reportable condition in the United States, and
its prevalence is unknown however, a pilot
registry at a Pennsylvania

• 2/2001 PICK contacts CDC
• 5/2001 Joint press conference
• 6/2001 Web site development
• http//www.cdc.gov/ncbddd/dd/kernicterus.htm
• 6/2001 MMWR http//www.cdc.gov/mmwr/preview/mmwrh
  tml/ mm5023a4.htm
• 6/2001 Local press coverage

Tighter Monitoring of Jaundice Urged by
CDCJaundice-Related Brain Syndrome Is Serious
but Preventable By  Sean Martin WebMD Medical
News June 14, 2001 (Washington) -- The CDC has
issued a call for better awareness of
kernicterus, a serious -- but preventable --
neurological
JAUNDICED NEWBORNS NEED IMMEDIATE ATTENTION By
Emma Patten-Hitt, PhD ATLANTA, Jun 14 (Reuters
Health) - Newborns with jaundice, a yellowish
tint to the skin, are at risk of developing a
severe and irreversible neurologic syndrome if
they are
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Methods

• Descriptive case series
• Convenient sample, surveyed by PICK
• Cases
• - DX of kernicterus since 1994
• - Gestation 37 weeks
• - Birthweight 2500 grams

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Results

• Four white males all breastfed and nursing well
  at discharge
• Jaundice noted on average at 28 hours old
• Readmission for jaundice on average at 9 days
• Mean follow-up TSB level was 34.7 mg/dL
• Treatment phototherapy (all) transfusion (2)
• Kernicterus DX at mean age of 7.5 months

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Case Conclusions

• Each case presented with significant jaundice
• Extreme hyperbilirubinemia is not expected from
  breastfeeding
• Further association between males and
  hyperbilirubinemia must be explored
• http//www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a4.
  htm

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CDC Responds to Kernicterus Calls
June 15, 2001 / 50(23)491-4 Kernicterus in
Full-Term Infants --- United States,
1994--1998 Kernicterus is a preventable life-long
neurologic syndrome caused by severe and
untreated hyperbilirubinemia during the neonatal
period. High levels of bilirubin are toxic to the
developing newborn. In full-term infants,
hyperbilirubinemia symptoms include severe
jaundice, lethargy, and poor feeding. Features of
kernicterus may include choreoathetoid cerebral
palsy, mental retardation, sensorineural hearing
loss, and gaze paresis. Kernicterus is not a
reportable condition in the United States, and
its prevalence is unknown however, a pilot
registry at a Pennsylvania

• 6/2001 CDC seminar
• 7/2001 JAMA reprints MMWR
• 7/2001 Exploring surveillance
• 10/2001 100,000 award - CDC collaboration with
  the American Association of Health Plans

Tighter Monitoring of Jaundice Urged by
CDCJaundice-Related Brain Syndrome Is Serious
but Preventable By  Sean Martin WebMD Medical
News June 14, 2001 (Washington) -- The CDC has
issued a call for better awareness of
kernicterus, a serious -- but preventable --
neurological
JAUNDICED NEWBORNS NEED IMMEDIATE ATTENTION By
Emma Patten-Hitt, PhD ATLANTA, Jun 14 (Reuters
Health) - Newborns with jaundice, a yellowish
tint to the skin, are at risk of developing a
severe and irreversible neurologic syndrome if
they are
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Public Health Implications

• Question clinical procedures
• The magnitude of the problem is unknown
• One case is one case too many
• Kernicterus can be prevented

jaundice
treatment
healthy baby
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Remember the Children