What are the typical symptoms of neonatal kernicterus?

What are the typical symptoms of neonatal kernicterus?

The severity of symptoms is related to factors such as bilirubin concentration and age.

Generally divided into four stages:

1. Warning period

The symptoms are relatively mild at around 256.5μmol15mg/dl, mainly manifested as inhibitory symptoms such as drowsiness, refusal to eat, decreased muscle tension, weakened or disappeared hug reflex, etc., and also manifested as apnea, bradycardia, and entering the spasm stage in about half a day to a day.

2. Spasm period

Symptoms include excitement symptoms such as convulsions, fever, muscle tension, screaming, kindness, nystagmus, difficulty breathing, convulsions or opisthotonos. Symptoms such as convulsions in premature infants are not obvious. Survivors will enter the recovery period after 1 to 2 days.

3. Recovery period

Sucking and responsiveness gradually return, then breathing improves and spasms decrease or disappear, lasting about 2 weeks.

4. Sequelae

Generally speaking, 2 months to 3 years after birth, the hands and feet move slowly, the eyes have difficulty turning upward or strabismus, hearing impairment, enamel hypoplasia with green or brown teeth, and the so-called tetralogy of extravertebral system damage is mainly present. In the follow-up of 835 cases of hemolytic disease in Shanghai, 48 cases of bilirubin encephalopathy included mental retardation, spasms or clonus, fatigue when raising the head, and drooling.

When symptoms appear, serum bilirubin sometimes decreases, which may be caused by the intake of bilirubin by the central nervous system and other tissues. We must not relax our vigilance. In recent years, brainstem auditory evoked potential detection has found that some serum bilirubin is 171-342μmol/L10-20mg/dl. Although children have no neurological symptoms, the potential curve IV and V waveforms disappear, and the brainstem nerve transmission time is prolonged, indicating auditory nerve dysfunction, which disappears after the bilirubin decreases. Perlman 1988 is called temporary subclinical bilirubin neurotoxicity, and believes that the effects of this bilirubin poisoning can be reversed and gradually recovered.