Bilirubin-Induced Neurologic Damage - Mechanisms and Management Approaches

The complex cascade of molecular and cellular events leading to bilirubin-induced neurotoxicity remains incompletely delineated. This review discusses bilirubin-induced brain damage and recent insights into its pathogenesis and prevention. Neonatal unconjugated hyperbilirubinemia and resultant clinical jaundice affect up to approximately 85% of newborns. Although this condition is generally a benign, transitional phenomenon, unconjugated bilirubin levels that can pose a direct threat of serious brain injury develop in a small proportion of neonates. Acute bilirubin encephalopathy may ensue and progress to kernicterus (chronic bilirubin encephalopathy), a permanent disabling neurologic condition that is classically characterized by the extrapyramidal movement disorders of dystonia, choreoathetosis, or both; hearing loss due to auditory neuropathy spectrum disorders; and oculomotor pareses.(1) These central nervous system (CNS) sequelae reflect the regional CNS topography of bilirubin-induced neuropathology, which ...