Liver-immaturity and treatment of kernicterus of the premature baby

Summary

• (1) There are different ways of showing that the liver of newborn normal children and even more of premature children is functionally immature.

• (2) This immaturity of the liver is the most important factor occasioning the kernicterus.

• (3) The kernicterus-situation can be defined through the contents of bilirubin in the blood of over 20 mg in 100 cc. with a low percentage of so-called direct bilirubin (under 10–15%).

• (4) Anoxaemia-defects of the brain, of the liver, or other organs raise the danger of kernicterus.

• (5) There is no prophylaxis or therapy for the icterus of premature babies which is not caused by incompatibility.

• (6) The only method is the exchange transfusion. It is not dangerous and can be performed even after the umbilicus has fallen off.

• (7) In spite of the exchange-transfusion a kernicterus-situation may occur a second time if bilirubin accumulated in the tissues is diffused into the blood. This requires a second exchange-transfusion.

• (8) Indications for exchange-transfusions:

• (a) Small premature children, critical situation more than 1 day.

• (b) heavier premature children, critical situation more than 3 days.

• (c) symptoms of anoxaemia require a rapid therapy, at the latest on the second day of a critical situation.