Kernicterus Associated with Perinatal Asphyxia and Drug Therapy

Abstract

Experimental studies suggest that a variety of factors play a role in the pathogenesis of kemicterus—protein-binding, acidosis, anoxia, hypoglycemia, etc. Certain drugs probably play a role also. At present, none of these factors are clearly enough defined or capable of quan titation even to the limited degree that is ac knowledged for the bilirubin level. However, their expressions are definite enough at this time to be considered when reaching what is still fundamentally a clinical judgment as to therapy in patients with hyperbilirubinemia in whom exchange transfusion is not clearly indi cated by the level of bilirubin alone or in com bination with blood type, hemoglobin, reticulo cyte count and Coombs test.

It seems clear that judgments about the safety of a drug for the fetus cannot be based entirely on experience with newborns or on experiments with newborn animals. The dan gers to a newborn infant which are inherent in a particular drug may be multiple and may not be fully known.