Kernicterus: Athetoid Cerebral Palsy, 6/2003 

Athetoid cerebral palsy is a form of CP that is characterized by uncontrolled movements of the trunk of the body, arms, and/or legs. In years past, it was often due to a large increase in the amount of a body chemical—bilirubin—in the blood of the newborn infant. This increase results in yellowing of the infant’s skin called jaundice. It also injures essential parts of the brain controlling the coordination of movements, the basal ganglia and the cerebellum. The brain injury is called Kernicterus and was a major cause of athetoid cerebral palsy. 

There are a number of reasons for an increase in blood bilirubin in the newborn infant; among these are a genetic factor preventing adequate bilirubin clearance from the infant’s blood; the effect of certain medications; an infection causing increased destruction of infant red blood cells (a product of red blood cell destruction is bilirubin) and Rh factor blood incompatibility between the mother and the infant resulting in increased infant red blood cell destruction. In the past, Rh blood factor incompatibility was a major cause of Kernicterus. 

With increased knowledge about blood types and Rh factors, improved methods of prevention were discovered. Also, methods for early detection of increased bilirubin and treatment were developed and applied; this later included photo (light) therapy and when necessary, an exchange blood transfusion. With control of the Rh factor incompatibility, the occurrence of new cases of Kernicterus almost disappeared and with that, the occurrence of athetoid CP diminished. 

However, there are new preliminary reports of an increased occurrence of high levels of bilirubin in the blood of newborns leading to jaundice and the development of Kernicterus¹. These reports have resulted in the government’s Center for Disease Control and Prevention (CDC) increasing its surveillance of newborns at risk of these disorders and stimulated other agencies to investigate the possible causes and develop even better methods of treatment. 

The UCP Research and Educational Foundation is monitoring this situation and will report on it as new information becomes available. Hopefully, the reason for the increase in blood bilirubin levels in the newborn can be brought under control. In any case, one additional infant with Kernicterus is one too many. 

¹Bhutani, V.K. et al. Hyperbilirubinemia and Kernicterus; Epidemiology, Etiology and Therapy. Ped Acad Societies Abstracts. May 2003: 398A
 

UCP Research & Educational Foundation, June 2003

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