KERNICTERUS ASSOCIATED WITH PERINATAL ASPHYXIA AND DRUG THERAPY

Experimental studies suggest that a variety of factors play a role in the pathogenesis of kemicterus—protein-binding, acidosis, anoxia, hypoglycemia, etc. Certain drugs probably play a role also. At present, none of these factors are clearly enough defined or capable of quan titation even to the limited degree that is ac knowledged for the bilirubin level. However, their expressions are definite enough at this time to be considered when reaching what is still fundamentally a clinical judgment as to therapy in patients with hyperbilirubinemia in whom exchange transfusion is not clearly indi cated by the level of bilirubin alone or in com bination with blood type, hemoglobin, reticulo cyte count and Coombs test.

It seems clear that judgments about the safety of a drug for the fetus cannot be based entirely on experience with newborns or on experiments with newborn animals. The dan gers to a newborn infant which are inherent in a particular drug may be multiple and may not be fully known.

KERNICTERUS IN NEWBORN RABBITS

Images

RED CELL GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY--A NEWLY RECOGNIZED CAUSE OF NEONATAL JAUNDICE AND KERNICTERUS IN CANADA

Seven male newborns of Chinese, Greek and Italian origin presented with severe hemolytic jaundice due to red cell glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. In five, the hemolysis was precipitated by inhalation of mothball vapours in the home. Kernicterus was evident upon admission in six infants and was fatal in four of these.G-6-PD deficiency should be suspected as a cause of jaundice in all full-term male infants of these ethnic groups. The diagnosis can be confirmed in any hospital by the methemoglobin reduction test. In areas similar to Toronto, Canada, where these high-risk ethnic groups prevail, the following measures are recommended: (1) detection of G-6-PD deficient newborns by screening cord bloods of all infants of these ethnic groups; (2) protection of affected infants from potentially hemolytic agents such as naphthalene, certain vitamin K preparations, and sulfonamides; and (3) observation of serum bilirubin levels to assess the need for exchange transfusion for hyperbilirubinemia.

OBSERVATION OF CHILDREN'S TEETH AS A DIAGNOSTIC AID: II. DEVELOPMENTAL DIFFICULTIES REFLECTED IN ENAMEL AND PIGMENT CHANGES IN TEETH

Current interest in tetracycline staining of teeth and other enamel defects led to this review. In the handicapped child structural defects that were seen in the dental enamel may provide a most accurate etiological clue. The method of determining the time of insult is described. Comments are made on seven states in which enamel dysplasia may be frequently observed. A simple means of identifying tetracycline pigment incorporated in dental enamel is outlined. Bilirubin staining of teeth is also shown and warnings are given about the indelible nature of these pigments.