title: The enigma of low bilirubin kernicterus in premature infants: why does it still occur, and is it preventable?
abstract: Low bilirubin kernicterus in preterm neonates, though rare, remains an unpredictable and refractory form of brain injury. Hypoalbuminemia, co-morbid CNS insult(s), infection, and inflammation are contributing causes that, in many cases, appear to interact in potentiating bilirubin neurotoxicity. Despite compulsive attention to serum bilirubin levels, and clinical and laboratory indices of neurotoxicity risk, low bilirubin kernicterus continues to be seen in contemporary NICUs. While efforts to refine and improve current treatment guidelines are certainly needed, such revision(s) will also have to take into account the risks and benefits of any intervention, including phototherapy.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: jwatchko@mail.magee.edu.
authors.forename: Jon F
authors.initials: JF
authors.lastname: Watchko
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI.
authors.forename: M Jeffrey
authors.initials: MJ
authors.lastname: Maisels
mesh_terms: D000818:Animals; D001663:Bilirubin / Q000097:blood*; D002821:Chorioamnionitis; D020345:Enterocolitis, Necrotizing; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000097:blood*; D007363:Intensive Care Units, Neonatal; D007647:Kernicterus / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D012307:Risk Factors; D018805:Sepsis
chemical_list: D001663:Bilirubin