BILIRUBIN ENCEPHALOPATHY

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Abstract
In babies of low birth weight dying in the 1st wk of life, bilirubin encephalopathy involving the thalamus only or the thalamus and 1 or 2 other areas occurred in 19 of 376 cases examined over a 10 yr period. Although coexistent germinal layer hemorrhage was present in 16, this was not thought to be an etiological factor. Bile stained hyaline membranes in 9 of the 19 were considered to indicate the possibility of protein-bound bilirubin traversing a vascular barrier in these cases. This pattern of predominant lateral thalamic involvement may indicate selective vulnerability of this area in this group. It contrasts sharply with the localization in classical kernicterus (3 cases) and in a disparate group where yellow discoloration of future white matter areas was observed (13 cases).