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Cerebral palsy in Singapore children.

Kernicterus was the major cause of cerebral palsy in 1965. The aetiology of kernicterus in Singapore differs from western countries in that glucose -six -phosphate dehydrogenase deficiency accounted for 43% of the children with kernicterus as shown by Wong (1). The other causes include liver immaturity, ABO incompatibility, sepsis, prematurity and Rhesus incompatibility. In 1968 Tan studied 577 cerebal palsied children and found that 31.5% were of the athetoid variety (2). The high incidence of athetosis compared to western countries is attributed to kernicterus in 56% in the neonatal period. Glucose -six -phosphate dehydrogenase is necessary in the hexose mono -phosphate shunt of glycolysis in the erythrocyte. Environmental factors responsible for triggering off haemolysis are herbs taken traditionally by nursing mothers and also exposure to napthalene used for storing the newborn babies clothes. Preventive measures directed towards kernicterus are the screening of cord blood for glucose -six -phosphate dehydrogenase at all government hospitals. All trigger factors, like herbs, are prevented from reaching the newborn baby and the baby is kept in the nursery from 21 days. In the event of neonatal jaundice occurring, a timely exchange transfusion is done. During the past 18 years, the number of kernicteric infants has been reduced to negligible