| Meaningful research |
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| In their first paper on the effects of asphyxia at birth in monkeys, Ranck and Windle (1959) noted that the pattern of ischemic brainstem lesions caused by asphyxia resembled the pattern of damage seen in kernicterus, but without the bilirubin staining. Others had already noted that bilirubin staining is not uniform throughout the brain, but only enters subcortical nuclei in which the blood-brain barrier had been compromised by anoxia or an infectious process (Orth 1875, Schmorl 1904,.Zimmerman & Yannet 1933). |
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| Bilirubin levels are normally high in newborn infants. This is not a recent development. Physiological jaundice of the newborn was recognized long before becoming viewed as pathological, and in need of eradication. Meaningful research into causes of kernicterus should be to focus on factors that cause break-down of the blood-brain barrier, and allow bilirubin to get into neurons. Further, why is bilirubin staining selective for certain subcortical nuclei? The finding of Ranck and Windle (1959) has anwered this question. |
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| The rank order of brainstem nuclei damaged by asphyxia at birth follow the same rank order of sites in the brain with highest blood flow and aerobic metabolism. Brainstem nuclei in the sensory pathways are metabolically more active that the memory system of the cerebral cortex. This does not make intuitive sense, but consider the activity of the auditory system. Fisch (1970) noted that the auditory system is always active, even during sleep. This is why alarm clocks were invented. The auditory system is the vigilance system of the brain, and in need of continuous high blood flow and metabolism. |
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