Jaundice Kernicterus

Jaundice (yellow color of skin, whites of the eyes) may occur when blood levels of bilirubin exceed normal (icterus). Jaundice may be characterized by an increase in unconjugated (indirect) bilirubin, conjugated (direct) bilirubin, or both. Accumulation of bilirubin (usually unconjugiated) in the brain (kernicterus) may result in death. When conjugated bilirubin increases, it may be excreted, giving a deep yeUow-red color to the urine. Examples of conditions associated with increased bilirubin and jaundice include the following. 

With severe hemolysis, more bihrubin is released into the blood than can be transported on albumin and conjugated in the liver. Unconjugated and total bilirubin increase and may produce jaundice and kernicterus. Examples include ... 

Pregnancy Category 6 Category D near term. Significant levels may persist in the neonate if these drugs are given near term jaundice, hemolytic anemia, and kernicterus may occur. Do not use at term. 

Jaundice is notitseifa disease but is an important diagnostic indicator of many underiying conditions, in newborns, jaundice can iead to toxic encephalopathy due to deposition of bilirubin within the lipid regions of membranes of the brain (kernicterus). 

C8. Crigler, J. F., and Najjar, V. A., Congenital familial nonhemolytic jaundice with kernicterus. Pediatrics 10, 169-179 (1952). 

Prevention alone is often not enough. Children still become jaundiced even after careful assessment. When this occurs.it is important to assess the risk of developing significant hyperbilirubinemia. The main concern is that the child will develop acute bilirubin encephalopathy, which is caused by the toxicity of bilirubin on the basal ganglia and other brain stem nuclei. There are early, middle, and late stages of acute bilirubin encephalopathy (Table 22-3). The term kernicterus is applied to chronic... 

Berberine displaces bilirubin from albumin and there is therefore a risk of kernicterus in jaundiced neonates (10). 

Phytomenadione given intravenously is generally tolerated well. However, intravenous administration of small amounts (2-5 mg) can be followed by severe short-lasting cyanosis, dyspnea, tachycardia, and low blood pressure in patients with cardiac failure. Flushing and sweating can occur. Anaphylactoid reactions may be due to the excipient Cremophor EL. The most important adverse effects are jaundice and kernicterus, which can occur in small and premature babies, even after small doses, probably because of immature liver function. 

Antibacterial and Antibiotic Drugs. Sulfonamides are extensively protein bound. If these drugs are administered to mothers immediately before delivery or to the premature or full term infant while there is physiological hyperbilirubinemia, they may displace bilirubin from plasma protein, causing severe jaundice or kernicterus [8]. 

In addition, there are some hepatic metabolic uses. Because hepatic glucuronyl transferase and the bilirubin-binding Y protein are increased by the barbiturates, phenobarbital has been used successfully to treat hyperbilirubinemia and kernicterus in the neonate. The nondepressant barbiturate phetharbital (A-phenylbarbital) works equally well. Phenobarbital may improve the hepatic transport of bihrubin in patients with hemolytic jaundice. 

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