Sections

Kernicterus

Medication

Medication Summary

No medications are available to treat the symptoms of acute or chronic bilirubin encephalopathy. Pharmacologic intervention is aimed at prevention. Current therapies are indicated as adjuncts to phototherapy when total bilirubin is approaching exchange level; experimental therapy continues with the use of bilirubin production inhibitors.

Class Summary

These methods decrease the amount of free bilirubin in the intravascular space, thus theoretically reducing the risk of neurotoxicity. Bilirubin is produced via induction of its enzymatic pathway and by RBC degradation. Inhibition of either of those 2 mechanisms can decrease the amount of bilirubin in the blood.

Albumin (Albuminar, Albutein, Plasbumin)

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Because bilirubin bound to albumin is not available to cross the blood-brain barrier, increasing the amount of serum albumin theoretically increases the amount of available binding sites and decreases free bilirubin. Efforts to quantify albumin-binding capability or serum levels of bound bilirubin have not proved to be clinically useful, although assessment of the bilirubin-to-albumin ratio have been incorporated into the decision-making algorithm for exchange transfusion. However, administration of albumin for the purpose of increasing bilirubin-binding capacity is not a recommended standard of care. It may be considered in cases of significant hypoalbuminemia. Measured albumin levels < 3 g/dL may be considered an additional risk factor for BIND when considering therapeutic interventions.

Immune globulin intravenous (Gamimune, Gammagard S/D, Gammar-P, Polygam S/D)

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Parenteral administration has been shown in controlled clinical trials to reduce the need for exchange transfusion in both Rh and ABO immune-mediated hemolytic disease. Its mechanism of action is not entirely clear.

Administration in hyperbilirubinemia resulting from isoimmune hemolytic disease that is unresponsive to phototherapy and/or is approaching exchange level has been recommended by the AAP in its 2004 revised clinical practice guideline.

Class Summary

Phenobarbital may increase hepatic conjugation and excretion. Decreased hepatic conjugation caused by normal delay in enzyme induction increases the amount of unconjugated bilirubin in the blood stream. Conjugated bilirubin does not pose a threat of neurotoxicity. Once conjugated, this nontoxic form of bilirubin proceeds toward intestinal excretion.

Phenobarbital (Luminal, Solfoton)

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Induces the hepatic enzymes involved in bilirubin conjugation and increases biliary excretion.

Do not administer intra-arterially. Dosing can be enteral or parenteral.

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Media Gallery

Kernicterus. Typical patterns of total serum bilirubin levels in neonates of different racial origins. Used with the permission of the Academy of Pediatrics.
Kernicterus. Overview of bilirubin metabolism.
Kernicterus. Hour-specific nomogram for total serum bilirubin and attendant risk of subsequent severe disease in term and preterm infants. Used with the permission of the Academy of Pediatrics.
Kernicterus. Magnetic resonance image of a 21-month-old with kernicterus. The area of abnormality is the symmetric high-intensity signal in the area of the globus pallidus (arrows). Courtesy of MJ Maisels.
Kernicterus. Neuronal changes observed in kernicterus. Courtesy of JJ Volpe.

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Author

Shelley C Springer, JD, MD, MSc, MBA, FAAP Professor, University of Medicine and Health Sciences, St Kitts, West Indies; Clinical Instructor, Department of Pediatrics, University of Vermont College of Medicine; Clinical Instructor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

Shelley C Springer, JD, MD, MSc, MBA, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

David J Annibale, MD Professor of Pediatrics, Medical University of South Carolina College of Medicine; Director of Neonatology, Director of Fellowship Training Program in Neonatal-Perinatal Medicine, Department of Pediatrics, Division of Neonatology, MUSC Children's Hospital

David J Annibale, MD is a member of the following medical societies: American Academy of Pediatrics, National Perinatal Association

Disclosure: Editorial staff for AAP NeoREVIEWS PLUS (includes reimbursement for meeting expecnses and $300 honorarium; Advisory meetings for the National Certification Corp. development of a QI certification test. (includes all expenses without honorarium) for: American Academy of Pediatrics, National Certification Corp.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Clark, MD Professor and Martha Lepow Chairman of Pediatrics, Professor of Obstetrics and Gynecology, Albany Medical College; Director, Children's Hospital at Albany Medical Center

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Forestry Association, American Pediatric Society, Capital District Pediatric Society, Christian Medical and Dental Associations, European Society for Paediatric Research, Eastern Society for Pediatric Research, Floyd W Denny Pediatric Alumni Society, Medical Society of the State of New York, New York Academy of Sciences, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Oussama Itani, MD, FAAP, FACN Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center

Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, American Heart Association, American College of Nutrition

Disclosure: Nothing to disclose.

Kernicterus Medication

Medication Summary

Blood Product Derivatives

Class Summary

Albumin (Albuminar, Albutein, Plasbumin)

Albumin (Albuminar, Albutein, Plasbumin)

Immune globulin intravenous (Gamimune, Gammagard S/D, Gammar-P, Polygam S/D)

Immune globulin intravenous (Gamimune, Gammagard S/D, Gammar-P, Polygam S/D)

Anticonvulsant Agents

Class Summary

Phenobarbital (Luminal, Solfoton)

Phenobarbital (Luminal, Solfoton)

Kernicterus Medication

Medication Summary

Blood Product Derivatives

Class Summary

Albumin (Albuminar, Albutein, Plasbumin)

Albumin (Albuminar, Albutein, Plasbumin)

Immune globulin intravenous (Gamimune, Gammagard S/D, Gammar-P, Polygam S/D)

Immune globulin intravenous (Gamimune, Gammagard S/D, Gammar-P, Polygam S/D)

Anticonvulsant Agents

Class Summary

Phenobarbital (Luminal, Solfoton)

Phenobarbital (Luminal, Solfoton)

References

Tables

Contributor Information and Disclosures

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