Kernicterus

Kernicterus and neonatal hyperbilirubinemia N. Ambalavanan MD Division of Neonatology University of Alabama at Birmingham Jan 2005 [email_address]

Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kernicterus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acute bilirubin encephalopathy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Chronic bilirubin encephalopathy (kernicterus) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigations (Volpe JJ:. 3 rd Ed., 1995) ,[object Object],[object Object],[object Object],[object Object]

Is kernicterus a problem? ,[object Object],[object Object],[object Object],[object Object],[object Object]

What is the incidence? ,[object Object],[object Object],[object Object]

Why is kernicterus a problem? ,[object Object],[object Object],[object Object]

Risk factors for hyperbilirubinemia in full-term newborns ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object]

Problems with serum bilirubin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Serum Bilirubin and Kernicterus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Old recommendations Management of Hyperbilirubinemia in the Healthy Term Newborn. Pediatrics 94: 558, 1994 Age,hours TSB Level, mg/dL (pmol/L) Consider Photo-therapy Phototherapy Exchange Transf. if Intensive Photo therapy Fails Exchange Transf. and Intensive Phototherapy <=24§ ... ... ... ... 25-48 > 12 (210) > 15 (260) > 20 (340) > 25 (430) 49-72 > 15 (260) > 18 (310) > 25 (430) > 30 (510) >72 > 17 (290) > 20 (340) > 25 (430) > 30 (510)

Is a serum bilirubin of 20-25 mg/dL safe? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Root cause analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Root cause: Patient assessment ,[object Object],[object Object],[object Object]

Root cause: Continuum of care ,[object Object],[object Object],[object Object]

Root cause: Patient and Family education ,[object Object]

Root cause: Treatment ,[object Object],[object Object]

Early identification: Nomograms ,[object Object]

How good is the nomogram? ,[object Object],[object Object],(+) predictive value (-) predictive value Sensitivity Specificity Above 95 th –ile 40% 98% 54% 96% Above 75 th -ile 22% 99.5% 91% 85% Above 40 th -ile 12% 100% 100% 65%

Transcutaneous measurement ,[object Object],[object Object],[object Object],[object Object]

Transcutaneous measurement ,[object Object],[object Object]

Early identification: CO ,[object Object],[object Object],[object Object],[object Object],COStat End-tidal breath analyzer (Natus Medical)

Newer methods of prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]

Early treatment is required! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AAP Clinical Practice Guideline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Key elements (contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]

Secondary Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]

Secondary Prevention ,[object Object],[object Object],[object Object],[object Object]

Laboratory Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lab Evaluation (contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Secondary Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Secondary Prevention ,[object Object],[object Object],[object Object]

Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk Factors (contd.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Timing of Follow-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Follow-up assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object]

Treatment (contd.) ,[object Object],[object Object]

Treatment (contd) ,[object Object],[object Object]

Outpatient Management of the Jaundiced Breastfed Infant ,[object Object],[object Object],[object Object],[object Object]

Kernicterus

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Kernicterus