KERNICTERUS IN OTHERWISE HEALTHY, BREAST-FED TERM NEWBORNS

Objective. To document the occurrence of classical kernicterus in full -term, otherwise healthy, breast-fed infants. Methods. Were viewed the files of 22 cases referred to us by attorneys throughout the United S tates during a period of 18 years, in which neonatal hyperbilirubinemi a was alleged to be responsible for brain damage in apparently healthy , nonimmunized, full-term infants. To qualify for inclusion, these inf ants had to be born at 37 or more weeks' gestation, manifest the class ic signs of acute bilirubin encephalopathy, and have the typical neuro logic sequelae. Results. Six infants, born between 1979 and 1991, met the criteria for inclusion. Their peak recorded bilirubin levels occur red 4 to 10 days after birth and ranged from 39.0 to 49.7 mg/dL. All h ad one or more exchange transfusions. One infant had an elevated retic ulocyte count (9%) but no other evidence of hemolysis. The other infan ts had no evidence of hemolysis, and no cause was found for the hyperb ilirubinemia (other than breastfeeding). Conclusions. Although very ra re, classic kernicterus can occur in apparently healthy, full-term, br east-fed newborns who do not have hemolytic disease or any other disce rnible cause for their jaundice. Such extreme elevations of bilirubin are rare, and we do not know how often infants with similar serum bili rubin levels escape harm. We also have no reliable method for identify ing these infants early in the neonatal period. Closer follow-up after birth and discharge from the hospital might have prevented some of th ese outcomes, but rare, sporadic cases of kernicterus might not be pre ventable unless we adopt an approach to follow-up and surveillance of the newborn that is significantly more rigorous than has been practice d. The feasibility, risks, costs, and benefits of this type of interve ntion need to be determined.