Articles: kernicterus.
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Pediatric emergency care · Sep 2004
Case ReportsAcute, severe bilirubin encephalopathy in a newborn.
In recent years, changes in health care practices including the early discharge of newborns have transformed the management of neonatal jaundice into an outpatient problem. At the same time, there has been a resurgence in the incidence of kernicterus. ⋯ We review the infant's presentation and hospital course, diagnostic and therapeutic interventions, and autopsy findings. In the current era of increased frequency of breast-feeding, shortened hospital stays, and inconsistent follow-up after hospital discharge, emergency department physicians should be alerted to the rare but increasing occurrence of severe hyperbilirubinemia and kernicterus.
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Clinics in perinatology · Sep 2004
ReviewUnderstanding and preventing severe neonatal hyperbilirubinemia: is bilirubin neurotoxity really a concern in the developed world?
Although rare, extreme neonatal hyperbilirubinemia and its dreaded complication, kernicterus, continue to occur. Hyperbilirubinemia develops when bilirubin production exceeds the body's capacity to excrete it, primarily by conjugation. ⋯ Adjuncts to the interpretation of the serum total bilirubin concentration are suggested. Prevention and management of severe hyperbilirubinemia should be based on American Academy of Pediatrics guidelines, with individualization including earlier institution of treatment and delayed discharge from the hospital for neonates with risk factors for kernicterus.
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Practice Guideline Guideline
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.
Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. ⋯ These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).