Neonatal jaundice is perhaps the most common of all pediatric problems
and hazardous levels of unconjugated bilirubin pose a direct threat of
permanent brain damage (kernicterus). Current population-based kernicterus
estimates of the prevalence for term neonates in developed countries range
from approximately 1:50,000 to 1:200,000. In low- and middle-income
countries, although the prevalence is unknown, kernicterus appears to be a
much more serious problem. Thus, the prevention of kernicterus remains a
concern for neonatal caregivers worldwide.
In
addition, it is now increasingly apparent that some neonatal
hyperbilirubinemia is the result of complex gene–environment
interactions and that the molecular pathogenesis of bilirubin-induced
neurotoxicity follows a cascade of events not previously appreciated. This
volume was designed to bring together the relevant basic science and
clinical information necessary for understanding the genesis of neonatal
hyperbilirubinemia and bilirubin-induced brain damage as well as information
regarding care of the jaundiced neonate. We are fortunate to have recruited
outstanding experts in the field who share their insightful perspectives
based on current knowledge and extensive clinical experience, so that this
book can serve as an essential reference for both practitioners and
investigators.
This volume addresses a broad
array of interrelated topics, ranging from the genetics, biochemistry,
transport, and metabolism of bilirubin to neonatal hyperbilirubinemia,
public policy measures, clinical management, and interventions designed to
prevent and treat neonatal hyperbilirubinemia and to reduce the burden of
bilirubin encephalopathy in developed and low- and middle-income countries.
The pathobiology of bilirubin-induced neurotoxicity, the clinical diagnosis
and outcome of kernicterus, and the important contributions of hemolytic
disease and glucose-6-phosphate dehydrogenase deficiency to neonatal
hyperbilirubinemia are detailed. The book also includes discussion of risk
assessment and treatment with phototherapy and other modalities.
Collectively the chapters complement each other; they point out gaps in
knowledge as well as consensus regarding practice. We hope that this book
provides both the clinician and the investigator with a firm basis for
future study and the stimulus to move the field forward.
David K. Stevenson, MD
M. Jeffrey Maisels,
MB BCh, DSc
Jon F. Watchko, MD