Kernicterus Treatment | PGI entrance Preparations

Kernicterus is treated by
A. Phenythydantoin
B. Barbiturate
C. Carbamazepine
D. Phenylbutazone
E. Penicillin

Ans. (B)

Barbiturates :

Kernicterus is a pathological condition of bilirubin (free undonjugated) toxicity of brain and is characterised by yellowish staining and necrosis ofbasal ganglia, hippocampal cortex, subthalamic nuclei, cerebellum and followed by gliosis of the area, Cerebral cortex generally spared. Critical level of bilirubincausing kernicterus varies from 15-20 mg/dl depending on maturity of baby. Hypoxia, acidosis, hypoglycemia, hypothermia or sepsis enhances the pathogenesis.

Treatment Includes

(i) Drugs : They act by:

— Interfering heme degradation,

— Accelerating normal bilirubin clearance,

— Inhibing enterohepatic clearance.

• It has very little role in practice.

• The drugs : Phenobarbitone, Tin (Sn) protoporphyrin or tin mesoporphyrin (-1- conversion of biliverdin to bilirubin by heme oxygenase).

(ii) Phototherapy.: Mechanism of action

- Native toxic unconjugated bilirubin (4z, 15z)

- Reversible Geometric

- Photoisomerisation

-Unconjugated configurational isomer (4z, 15E)

• In phototherapy:

- Light use: blue range 420 — 480 nm

- Combination of white (50O— 600 nm) and

- Eye should shielded with eye patches.

• Exchange therapy indications

(i) Failure with phototherapy