drjoe,
This is a very interesting question, and I would be interested to know
what prompted you to ask this question.
I found no documentation of kernicterus as the cause of fever. As
pinkfeud stated, fever can accompany kernicterus, but no case of
kernicterus induced fever turned up in my search. You stated in your
question the usual cause of fever “an underlying infection” Babies
with kernicterus are already in a compromised condition, and are prone
to infection.
An elevated bilirubin level usually seen only in newborns, especially
premature newborns, as you probably already know, causes Kernicterus.
Fortunately, it is very rare.Bilirubin, an oily yellow pigment, is a
product of normal red blood cell destruction. Newborns don’t posses
adequate intestinal bacteria to break down this bilirubin for
excretion. Newborns also have an enzyme that allows this bilirubin to
be reabsorbed from the gut, into the bloodstream. When the blood level
of bilirubin reaches 14- 18 mg/dl, the baby appears jaundiced (a
yellowish tinge to the skin, and especially evident in the sclera, or
whites of the eyes).As the baby matures, she/he develops the
intestinal flora necessary to excrete this by- product of red cell
breakdown and jaundice/hyperbilirubinemia ceases.
Hyperbilirubinemia is the term used for elevated blood levels of
bilirubin, and kernicterus is the term for the accumulation of
bilirubin in the brain tissues. Kernicterus can occur when the blood
bilirubin level reaches 20-25mg/dl, depending on the presence of
hemolysis and whether or not the bilirubin is conjugated or
unconjugated. (Bound to albumin or not) and can cause brain damage,
mental retardation, cerebral palsy, and more. The earliest symptoms of
kernicterus are drowsiness, vomiting, and lack of appetite.
http://www.mercksource.com/pp/us/cns/cns_health_library_frame.jsp?cd=3&pg=http://www.merck.com/pubs/mmanual_home/sec23/252.htm
http://www.bumc.bu.edu/www/busm/cme/modules/hbili/rthk.htm
This site does mention the fever of acute bilirubin encephalopathy,
and states that fever is not related to any recognizable causes.
http://www.neonatology.org/syllabus/kernicterus.html
A very nice Power Point Slide show explaining bilirubinemia is to be
seen here. (You need to click your mouse to advance the text and the
slides)
file:///C:/WINDOWS/Temporary%20Internet%20Files/Content.IE5/DCOVBZO7/267,13,Mechanism
Did you know that UV light is the treatment of choice for kernicterus?
At one time, the little cuties had small black patches taped over
their eyes, for protection, and they were placed in an isolette under
a UV light. Today, many hospitals wrap babies in special UV blankets
called biliblankets, for total body coverage. OF course, the little
black eye patches are still applied. The blankets are similar to
electric blankets, but have small plastic tubing running all over the
surface. The tubing contains lots of small UV lights for maximum body
coverage. In the “old days” folks would set their babies in the
window, or take them outside, as sunlight contains plenty of UV rays!
For very critical cases, blood transfusion may be ordered.
http://www.kernicterus.org/
http://www.cs.nsw.gov.au/rpa/neonatal/html/nursing/photo.htm
If my answer did not satisfy your requirements, please don’t hesitate
to ask for a clarification.
-crabcakes
Search terms:
kernicterus + hyperbilirubinemia
kernicterus + fever
fuo + hyperbilirubinemia
UV light therapy + hyperbilirubinemia |
