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Kernicterus is a condition associated with high levels of bilirubin in the blood in early life that may present with severe neurological symptoms.

Unconjugated bilirubin is lipid soluble and travels in the circulation largely bound to albumin. However, if the levels of unconjugated bilirubin are high a small fraction of free bilirubin escapes from the vascular compartment and enters the cellular lipid fraction of brain cells, causing a brain damage that may or may not be permanent, i.e. kernicterus.

NICE suggest that clinicians should identify babies with hyperbilirubinaemia as being at increased risk of developing kernicterus if they have any of the following:

  • a serum bilirubin level greater than 340 micromol/litre in babies with a gestational age of 37 weeks or more
  • a rapidly rising bilirubin level of greater than 8.5 micromol/litre per hour
  • clinical features of acute bilirubin encephalopathy


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