From Medscape today:

Jaundiced Neonates Require Prompt Attention

ATLANTA (Reuters Health) Jun 14 - Even healthy, full-term neonates with
jaundice may develop kernicterus if left untreated, the US Centers for
Disease Control and Prevention warns.
In the June 15th issue of the CDC's Morbidity and Mortality Weekly Report,
the CDC reports on four such cases of kernicterus. The information was
gathered through a survey conducted by a US support group for parents of
children with kernicterus.
"Each of these white male infants was nursing normally when discharged but
shortly after developed feeding problems," CDC officials note. "A historic
cohort study suggests boys are more susceptible than girls to adverse
outcomes from hyperbilirubinemia."
In one case, an infant was taken to a clinic because of signs of jaundice 9
days after his birth. The condition was thought to be due to breast-feeding
and the infant was sent home. That evening he became lethargic and his skin
turned a "pumpkin-orange" color. Even though treatment for
hyperbilirubinemia was initiated at age 11 days, he was diagnosed with
kernicterus at 6 months.
In the second case, jaundice was observed a few hours after birth, but
hyperbilirubinemia were not diagnosed and treated until day 5. The third
infant appeared jaundiced at age 2 days but was not properly diagnosed and
treated until day 6. The fourth infant appeared jaundiced at age 22 hours
but was not diagnosed with hyperbilirubinemia until day 12. All three
infants were diagnosed with kernicterus several months later.
"Jaundice needs to be recognized and treated in otherwise healthy full-term
infants in order to prevent brain damage and permanent disability from
kernicterus," Dr. Rachel Nonkin Avchen of the CDC told Reuters Health.
She reminds physicians that some of the early warning signs of kernicterus
are very yellow or orange skin tones (beginning at the head and spreading to
the toes); increased sleepiness, so much that it is hard to wake the infant;
a high-pitched cry; poor sucking or nursing; weakness, limpness, or
floppiness in body tone; and arching of the baby's body.
MMWR Morb Mortal Wkly Rep 2001;50:491-496.
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Anna Swisher
LLL Leader
Austin, TX

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