[Pathogenesis of bilirubin encephalopathy and subsequent therapeutic consequences]

At present the classic "kernicterus" has nearly disappeared, but toxic effects of bilirubin, nevertheless, play an important role in the etiology of late neurologic sequelae in VLBW infants. Even in very low concentrations of serum bilirubin CNS damages have to be expected when other metabolic disturbances induce the opening of blood-brain-barrier. Since safe criteria for predicting toxic effects of bilirubin do practically not exist, in VLBW infants with perinatal metabolic disorders early preventive phototherapy is indicated to keep the serum bilirubin level as low as possible. Experimental studies in animals showed brain protective effects of barbiturates apart from enzyme induction.