Kernicterus is a preventable but devastating neurologic disorder with life long complications. It is caused by severe and inadequately treated hyperbilirubinemia during the newborn period. In the present paper potential causes and risk factors for the occurrence of kernicterus related to the Thai health system that are responsible for the care of newborn infants before and after discharge are d...

The peroxidase method described in this paper measures non–protein-bound bilirubin by oxidation of the free fraction. The oxidation rate is slow compared with rapid dissociation of albumin-bound bilirubin. Thus, the unbound bilirubin can be estimated from the initial rate of decline in total bilirubin concentration. In the 1970s, severe neonatal hyperbilirubinemia and kernicterus were major cli...

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. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy whi...

Background: Exchange transfusion (ET) for severe neonatal hyperbilirubinemia (SNH) is frequently undertaken in lowand middle-income countries (LMIC), in sharp contrast to the prevailing practice in high-income countries. However, the criteria for initiating this procedure in settings with limited resources for treating infants with SNH have not been systematically explored. Objective: To identi...

Background: Exchange transfusion (ET) for severe neonatal hyperbilirubinemia (SNH) is frequently undertaken in lowand middle-income countries (LMIC), in sharp contrast to the prevailing practice in high-income countries. However, the criteria for initiating this procedure in settings with limited resources for treating infants with SNH have not been systematically explored. Objective: To identi...

Jaundice is common in healthy newborn infants. It is the result of normal adaptive physiological processes and generally peaks in severity between 3 and 5 days after birth and then resolves over the next 7 to 10 days. When bilirubin rises to toxic levels, bilirubin encephalopathy and subsequent kernicterus can occur. Phototherapy is a well-established and safe treatment of neonatal jaundice. A ...

We cared for a term male infant born to Burmese immigrants. At about 24 hours a total serum bilirubin (TSB) was 9.3 mg/dL, and phototherapy was begun. It was stopped 48 hours later, with a TSB of 10.9 mg/dL, and he was discharged from the hospital with an appointment for a repeat TSB check 48 hours later. A few hours before the appointment he became listless and apneic, and his parents took him...