KERNICTERUS

Abstract

A study of etiologic factors in 55 consecutive cases of kernicterus seen at autopsy disclosed the existence of a large, seemingly heterogeneous group in which erythroblastosis fetalis was not a causative factor. In 21 cases which had shown the characteristic features of erythroblastosis fetalis as regards family history, order number of pregnancy, racial distribution, clinical symptoms, hematologic findings and autopsy observations, the distribution of Rh types of mothers and infants was typical of erythroblastosis fetalis and maternal isoimmunization against Rh was readily demonstrated in 20 instances, the 21st having been studied before adequate technics were available. By contrast the clinical features were not characteristic of erythroblastosis in a second group of 32 patients which also differed from the first by its incidence of first born infants and by a high percentage of Negroes. In 20 of these 32 case studies of the Rh types of mothers and infants had been made, showing only one instance in which the combination of Rh-negative mother and Rh-positive infant was present. In no instance was it possible to demonstrate maternal Rh antibodies or sensitization of fetal erythrocytes. In the majority of the cases tested mother and infant were compatible in regard to blood group A-B-O. The incidence of incompatibility between mother and child in the A-B-O system was higher than expected in this group and appeared statistically significant. In no instance, however, was it possible to demonstrate unusually high agglutinin titers or immune antibodies against A or B in the maternal serum. The over-all clinical picture of the A-B-O incompatibility group did not differ from that of the patients with compatible blood groups. A-B-O incompatibility may be a predisposing factor in kernicterus but no conclusive evidence for this hypothesis was uncovered by these studies. The conclusion was reached that kernicterus does not represent a specific entity. Prematurity, severe infections, diarrheal disease, pulmonary and cerebral hemorrhage and maternal diabetes were the chief conditions encountered in those cases of kernicterus in which erythroblastosis fetalis was excluded.