KERNICTERUS as a clinical entity has been clearly associated with hyperbilirubinemia.1 Plasma bilirubin levels exceeding 20 mg/100 cc are considered levels above which kernicterus can occur; yet, it is known that kernicterus can occur in infants at bilirubin levels considerably below 20 mg/100 cc, while much higher levels can be innocuous.2 Normally, circulating bilirubin is entirely bound to albumin, and in vitro studies have shown that each mole of albumin can bind two3 or three4 moles of bilirubin. Odell5 showed that salicylates and sulfonamides may displace protein-bound bilirubin, emphasizing that the quantity of bilirubin that becomes unbound, and diffusible, may be of more importance in the production of kernicterus than the total bilirubin present in plasma. Silverman6 noted that premature infants treated with sulfisoxazole developed kernicterus six times more frequently than controls. It has been shown, however, that the cleavage of the bilirubin-albumin linkage
MENKEN M, BARRETT PVD, SWARM RL, BERLIN NI. Kernicterus: Development of an Experimental Model Using Bilirubin 14C. Arch Neurol. 1966;15(1):68–73. doi:10.1001/archneur.1966.00470130072007
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