PEDIATRICS Vol. 115 No. 3 March 2005, pp. 829a-830 (doi:10.1542/peds.2004-2380)
Prevention of Kernicterus: A Lesson From the Past
Jonathan B. Rosefsky, MDHaverford, PA 19041
To the Editor.—
A conference on bilirubin and kernicterus was summarized recently by Blackmon et al.1 The focus on knowledge gaps in 5 areas will be helpful. However, a painful lesson is that the absence of those answers 15 years ago should not have been a rationale for stopping the then-extant use of phototherapy and perhaps extra-clear liquids, absent any serious consequences derived from properly applied phototherapy. Why? Because, otherwise, therapeutics in the first half of the 20th century would have withheld penicillin from use until determining that it inhibited bacterial cell-wall synthesis, withdrawn aspirin from use until its suppression of pain and inflammation was biochemically clear, or prevented digitalis' beneficial use to society for hundreds of years.
The first paragraph of the article states:
"The reemergence of . . . [kernicterus had] resultant devastating neurologic consequences among the survivors . . . in the past 15 years. [The] disorder . . . began to be encountered unexpectedly among apparently healthy term and near-term infants, in the absence of Rh isoimmunization."1(p229)
Resistant bacteria may "reemerge"; kernicterus did not. Forgetting about what kernicterus was, and how quickly and devastatingly it could occur, is about reinventing the wheel.
Kernicterus "unexpected?" Like the constant vigilance for child abuse, congenital hip dislocation, or hypertension, kernicterus was always waiting in the wings for simple, appropriate observation and a high index of suspicion to drop below the threshold for detection and preventive intervention.
Therapeutic nihilism by health care professionals also played a major role: "Wait until ..., " "You [parent] call me if ... ," or "Don't worry, this is just common jaundice." Preservation of neurologic integrity requires any and all modalities.
We need to learn from the past, from teachers, and from reading (a "new" section in Pediatrics?) about past triumphs and therapy, even if we didn't know all the exquisite theory at the time. With kernicterus, history repeated itself.
REFERENCE
- Blackmon L, Fanaroff A, Raju T. Research on prevention of bilirubin-induced brain injury and kernicterus: National Institute of Child Health and Human Development conference executive summary.
Pediatrics. 2004;114
:229
–233
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
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