Nuclear jaundice in neonatal (umbilical) sepsis with jaundice.

It is a well-known fact that after familial jaundice in the new-born there not rarely remain certain cerebral symptoms which are related to a particular localization of the icteric staining in the brain substance, especially in the basal ganglia. The first description of icterus gravis neonatorum was given by Orthl', and the familial character was stressed by Schmorl2. In recent years a number of articles on this subject have appeared. In America it was discussed extensively by Zimmermann and Yannet', and recently by Astrachansa, in England by Hawksley and Lightwood4, in France by Pehu, Brochier and Wang' and in Holland by C. de Lange6. The relationship of icterus gravis neonatorum to hydrops foetalis and congenital anaemia has been studied recently by Diamond, Blackfan and Baty' and by Parsons, Hawksley and Gittins8. On the cause of the peculiarly localized icteric staining in the brain as well as on the etiology of icterus gravis neonatorum there exist different opinions which have been summarized recently in the articles of Zimmermann and Yannet, of Hawksley and Lightwood, and of Pehu, Brochier and Wang. Next to the question of the etiology of icterus gravis neonatorum and of nuclear jaundice occurring with it, two other questions related to this subject have occupied the attention of both older and more recent investigators. One is the treatment of icterus gravis neonatorum which has been and still is a widely-discussed problem. The other question which is to be specially discussed in the present article is whether nuclear jaundice in the new-born is a peculiarity of icterus gravis neonatorum. As regards the last-mentioned question there are no cases with autopsy records which can help to solve the problem. There only exists the clinical description of a case of neonatal septic jaundice with extrapyramidal disturbances in motility, given by C. de Lange9 in which it is suggested that in this form of neonatal jaundice icteric staining of the basal ganglia may also occur. However, no autopsy was possible in this case.