Kernicterus: The continuing occurrence of a preventable chronic disabling neurologic condition

Background: Kernicterus is a preventable condition that has become increasingly rare in many countries in the world. It is chronic severe form of bilirubin-induced neurological dysfunction that is associated with a variety of metal and neurological abnormalities resulting from bilirubininduced brain damage mostly in the basal ganglia and during the neonatal period. Despite the condition has been increasingly considered as preventable, it is still seen in some geographic areas where diagnostic and preventive interventions continue to experience failures. The aim of this paper is to emphasize the continuing occurrence of a preventable chronic disabling neurologic condition, and also to warn from the lack of advancement of preventive services in this geographic region. Patients and methods: Two unrelated patients with kernicterus observed at the Children Teaching Hospital of Baghdad Medical City are described. Results: The first patient was a seven-year old boy who was seen during the year 2019. He experienced neonatal hyperbilirubinemia of 28 mg/dL, and developed kernicterus presenting with mental retardation associated with delayed motor and speech development despite normal hearing, over-activity and behavioral abnormalities. The second patient was a two-year and eight months old girl who was also seen during the year 2019. She developed neonatal hyperbilirubinemia of 24 mg/dL that was attributed to ABO blood incompatibility, and required an exchange transfusion. The girl was spastic and had delayed speech and development and was unable to sit or stand without support. The patients were initially treated based on our extensive published experiences with the treatment of various neurologic disorders including cerebral palsy and kernicterus. However, they couldn't be followed because of the emergence of covid-19 global pandemic. Conclusion: Although kernicterus has become increasingly rare in many countries in the world, it is still seen in areas with poor preventive services