Turkel S B, Miller C A, Guttenberg M E, Moynes D R, Godgman J E
Pediatrics. 1982 Mar;69(3):267-72.
Kernicterus at autopsy, traditionally associated with hyperbilirubinemia, is now often observed in the absence of markedly elevated levels of serum bilirubin. Attempts to document clinically predictive risk factors for kernicterus have been largely unsuccessful in the current population of sick neonates. In a study of 32 pairs of newborns with and without kernicterus at autopsy and matched for gestational age, weight, length of survival, and year of birth, no differences were found when multiple clinical factors thought to potentiate risk for kernicterus were compared. Microscopic sections of brains from these matched pairs were then evaluated without knowledge of the clinical or gross findings according to prearranged criteria. Statistic analysis of the microscopic findings was done, comparing each observed change in each anatomic site, all changes in each site, and each change in all sites. Although the gross pattern of staining followed that of classic kernicterus, the expected, specific histologic changes characteristic of kernicterus were found in only three patients. Spongy change, or edema, was significantly more common in the grossly stained brains (P less than .0005), but other findings were similar in both groups. Gross bilirubin staining of the neonatal brain with neither hyperbilirubinemia nor specific microscopic changes is probably not the same clinicopathologic entity as classic kernicterus.
尸检时发现的核黄疸，传统上与高胆红素血症相关，现在在血清胆红素水平无明显升高的情况下也经常观察到。在目前患病新生儿群体中，试图记录核黄疸临床预测风险因素的尝试大多未成功。在一项针对32对尸检时有无核黄疸且在胎龄、体重、存活时间和出生年份上匹配的新生儿的研究中，当比较多种被认为会增加核黄疸风险的临床因素时，未发现差异。然后在不知道临床或大体检查结果的情况下，根据预先设定的标准对这些匹配对的脑显微切片进行评估。对显微检查结果进行统计分析，比较每个解剖部位观察到的每种变化、每个部位的所有变化以及所有部位的每种变化。尽管大体染色模式遵循经典核黄疸的模式，但仅在三名患者中发现了核黄疸预期的、特定的组织学变化。海绵样改变或水肿在大体染色的脑中明显更常见（P小于0.0005），但两组中的其他发现相似。新生儿脑的大体胆红素染色，既无高胆红素血症也无特定的显微变化，可能与经典核黄疸不是同一临床病理实体。
