The Reemergence of Kernicterus

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The Re-emergence of Kernicterus
Prevention, Promise the Power of Partnerships

• Sue Sheridan
• President, PICK

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Pilot Kernicterus Registry USA (Voluntary
Reporting)
Term and Near Term Healthy Infants by Year of
Birth
Cases as of September 2002 (including 2 from U.S.
Army Camps in Germany)
BIND CENTER - Pennsylvania Hospital
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Confirmed Cases of Acute Kernicterus(Voluntary
Reporting)
Healthy Term and Near Term Infants Born in 34
States
n 125 cases 34 States as of September 2002 (two
cases reported from U.S. German Army Camps)
BIND CENTER - Pennsylvania Hospital
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Identified Oversights in the Management of
Jaundice
(Johnson, Brown, Bhutani Journal of Pediatrics
April 2002)

• Loss of concern about the neurotoxic potential of
  bilirubin
• Limitations of visual recognition of jaundice
• Failure to recognize severity of
  hyperbilirubinemia corrected for age in hours
• Failure to ensure timely follow-up
• Delay in intensive or timely interventions

BIND CENTER - Pennsylvania Hospital
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Potential Adverse Outcomes for Newborn Jaundice

• Death respiratory failure (n6 in Pilot KI
  Registry)
• Acute bilirubin encephalopathy
• Post-icteric sequelae (neuromotor/auditory)
• Subtle manifestations (extra-pyramidal and
  central processing disorders)

CLINICAL SPECTRUM Bilirubin Induced Neurologic
Dysfunction (BIND)
BIND CENTER - Pennsylvania Hospital
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Bilirubin Care Map to Prevent Acute Bilirubin
Encephalopathy
Crash-Cart Interventions
99th ile
Intensive Phototherapy for TSB rise gt0.20
mg/dl/hr
95th ile
TSB Follow-up in 6-12hrs
75th ile
TSB/TcB MD Follow-up 24hrs
40th ile
TcB Follow-up 48hrs
Clinical follow-up or Transcutaneous
Bilirubin within 48 hrs of discharge at MD
discretion
Check for Jaundice every 8 to 12 hours
BIND CENTER - Pennsylvania Hospital
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NQF Report