March 1986

Picture of the Month

Am J Dis Child. 1986;140(3):247-248. doi:10.1001/archpedi.1986.02140170073032

Denouement and Discussion 


Manifestations  Kernicterus develops in infants who have had severe neonatal, unconjugated hyperbilirubinemia. Initial manifestations consist of lethargy, hypotonia, poor feeding, and loss of Moro and rooting reflexes. Subsequently opisthotonos develops along with downward deviation of the eyes ("setting sun" sign). Other findings include fever, seizures, gasping respiration or dyspnea, and ultimately pulmonary hemorrhage. Manifestations of kernicterus later in life consist of spasticity, choreoathetosis, sensorineural deafness, and vertical gaze palsy.The effective prevention of the Rh isoimmunization and the use of phototherapy and exchange transfusions to prevent or reduce high levels of serum unconjugated bilirubin have been responsible for the marked decrease of kernicterus in newborns. Kernicterus does occur, however, in the immature, sick, preterm infant. Histologic examination of the brain of such an infant grossly

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