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Nuclear jaundice
Last reviewed: 08.07.2025
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Kernicterus (bilirubin encephalopathy) is a brain injury caused by the deposition of bilirubin in the basal ganglia and brainstem nuclei.
Normally, bilirubin bound to albumin remains in the intravascular space. However, bilirubin can penetrate the blood-brain barrier and cause bilirubin encephalopathy at significantly elevated bilirubin concentrations; significantly decreased serum albumin concentrations (e.g., in premature infants); when bilirubin is displaced from its albumin binding by competing substances (e.g., sulfisoxazole, ceftriaxone, aspirin; free fatty acids and hydrogen ions during starvation, sepsis, or acidosis).
[ Symptoms of nuclear jaundice
A premature baby with the development of bilirubin encephalopathy does not always have classic signs. The first symptoms of nuclear jaundice in full-term babies are lethargy, decreased appetite, vomiting. Then opisthotonus, seizures and death may develop. Nuclear jaundice can lead to mental retardation, choreoathetoid cerebral palsy, sensorineural hearing loss, and upward gaze palsy. It is unknown whether mild degrees of bilirubin encephalopathy can cause less severe neurological disorders (for example, perceptual-motor disorders and learning disorders).
Treatment of nuclear jaundice
There is no treatment for bilirubin encephalopathy once it has developed. Kernicterus is prevented by treating hyperbilirubinemia.