Kernicterus in erythroblastosis fetalis

Abstract

Summary In a series of seventy-two cases of erythroblastosis fetalis there were twenty-fivedeaths with twenty-one autopsies. Four of the surviving patients have mental retardation. An unfavorable outcome was associated with the clinical or pathologic signs of kernicterus in twenty cases. In twelve cases of kernicterus there were also focal pulmonary hemorrhages and these infants displayed a striking clinical picture, made up variously of drowsiness, spasticity, opisthotonos, signs of motor irritability, respiratory irregularity, pulmonary râles and rhonchi, and bloody discharge from the upper respiratory tract. Clinical and pathologic features of the cases with kernicterus suggest thatblood destruction is not the primary determinant of nuclear damage. The possible roles of immaturity, vascular injury, altered antigen-antibody reactivity, and intrapartum transfer of antibody in the pathogenesis of kernicterus are discussed.