Assessing the risk of kernicterus using nuclear magnetic resonance

Kernicterus is the end result of injury to the central nervous system by bilirubin and other factors. Serum bilirubin levels alone are poor predictors of kernicterus especially in sick preterm infants. We need a rapid noninvasive indicator of neurotoxicity and impending cell injury. Bilirubin first seems to affect neuronal conduction before energy metabolism is impaired. Unchecked, this may lead to failure of ATP synthesis, resulting in the breakdown of all active intracellular processes. It is now possible to measure energy metabolism in vivo and noninvasively by surface coil 31P NMR spectroscopy. Recent animal studies demonstrate perturbations in energy metabolism when hyperbilirubinemia is associated with an open BBB. Perhaps the further developments in NMR spectroscopy and imaging will permit regional assessment of impending or actual bilirubin neurotoxicity and allow us to identify those infants in need of immediate treatment.