On Mon, 17 Sep 2007 00:45:49 -0400, Diana Cassar-Uhl 
<[log in to unmask]> wrote:

>
>if you look on the Bhutani curve for risk of
>kernicterus,<<<


I just have to correct this.  The idea that the Bhutani curves predict 
kernicterus is incorrect but frequently stated.  The curves simply show who is  
at risk for having their current level of bilirubin get higher.  The assumption is 
that the higher the bilirubin, the greater the risk for kernicterus, which is not 
exactly true.  

In order to predict the risk, we would need to know a lot more about 
kernicterus.  A definition, incidence, prevalence....And we only recently 
decided on a definition of the disease.

I would encourage reading of Dr. Bhutani's own article in Pediatrics, Feb 
2006....Toward Understanding Kernicterus: A Challenge to Improve the 
Management of Jaundiced Newborns Richard P. Wennberg, Charles E. Ahlfors, 
Vinod K. Bhutani, Lois H. Johnson, and Steven M. Shapiro
Pediatrics 2006; 117: 474-485.

It discusses the concept of protein-binding of bilirubin, analogous to thyroid 
disease, with free and bound states.  Free bilirubin may be the culprit but we 
just don't know.  My favorite line from the article is this:  "TSB [total serum 
bilirubin] is, at best, a poor risk indicator for kernicterus and, at worst, an 
excuse for not intervening when intervention is necessary."


Jenny Thomas

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