Published online March 1, 2005
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 830 (doi:10.1542/peds.2004-2815)
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Prevention of Kernicterus: A Lesson From the Past: In Reply

Lillian R. Blackmon, MD, FAAP
Department of Pediatrics,
University of Maryland School of Medicine,
Baltimore, MD 21201

Avroy A. Fanaroff, MD, FAAP
Department of Pediatrics,
Case Western Reserve University School of Medicine,
Cleveland, OH 44106

Tonse Raju, MD, FAAP
Pregnancy and Perinatology Branch,
National Institute of Child Health and Human Development,
Bethesda, MD 20892-2425

In Reply.—

We appreciate the opportunity to respond to the thoughtful letter from Dr Rosefsky regarding our summary of the recent National Institute of Child Health and Human Development conference on prevention of bilirubin-induced brain injury and kernicterus.1 We heartily agree with Dr Rosefsky's concern about learning from our past experiences while emphasizing the constant need to add new knowledge through research. The conference attempted to identify the areas in which research is needed to augment our current knowledge and practice.

The recent upsurge in recognizing kernicterus seems to be the result of a convergence of otherwise unrelated forces in primary care, including but not limited to shortened newborn hospital stays, heavy emphasis on breastfeeding without an adequate support infrastructure, iatrogenic maturation of 35- to 37-week-gestation newborns in terms of neonatal management, and a lack of urgency about neonatal hyperbilirubinemia in otherwise healthy infants. One important need is an accurate measure of the problem, and thus the recommendation for systematic surveillance and reporting was made.

REFERENCE

  1. 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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