The American Academy of Pediatrics (AAP) Subcommittee on Hyperbilirubinemia is currently revising the practice parameter (guidelines) on neonatal hyperbilirubinemia published in October 1994. Although this revision is in progress, the Subcommittee wishes to bring the issue of kernicterus to the attention of the pediatric community and provide additional information pending a more formal assessment of the literature and an analysis of the risks and benefits of new approaches to the jaundiced infant. The Joint Commission on Accreditation of Healthcare Organizations has already issued an alert on this subject.

Kernicterus, or bilirubin encephalopathy, is a condition caused by bilirubin toxicity to the basal ganglia and various brainstem nuclei. In the acute phase, severely jaundiced infants become lethargic, hypotonic and suck poorly. If the hyperbilirubinemia is not treated, the infant becomes hypertonic and may develop a fever and a high-pitched cry. The hypertonia is manifested by backward arching of the...

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