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970 IRRELEVANCE OF RISK FACTORS IN PREDICTING KERNICTERUS

Elevated serum bilirubin in the neonatal period has been related to the occurrence of kernicterus at autopsy. The level of bilirubin believed to be critical has been decreasing, especially for the small premature. To our knowledge, a controlled study of those factors potentiating kernicterus at relatively low levels of bilirubin has not been done. Thirty infants found at autopsy to have kernicterus (gross bilirubin staining of the basal ganglia) were matched with 30 other autopsied infants for gestational age, birthweight, life span and year of birth. These infants were collected from January 1971 to January 1977. In each group, 6 weighed < 1,000 gms., 9: 1,000-1,500, 6: 1,500-2,500, and 4 > 2,500. Gestational age ranged from 25 to 41 weeks and length of survival from 1 to 28 days. Autopsy findings, clinical histories and laboratory profiles were examined for known potentiating factors and no significant differences were found for serum pH, pO2, pCO2, hematocrit, glucose, Apgar scores, temperature, blood group incompatibility and hydration. The average peak level of bilirubin was low in both groups and while slightly higher in the group with kernicterus, this difference was only minimally significant (paired t-test, p-0.05). The presence of kernicterus in these infants may not be preventable by controlling serum bilirubin to low levels. The levels of bilirubin demanding therapeutic intervention in the high risk infant needs re-evaluation.