**Question:** The late features of kernicterus include all except -

A. Drowsiness and lethargy
B. Decreased reflexes
C. Motor weakness
D. Seizures

**Core Concept:** Kernicterus is a neurological complication of severe hyperbilirubinemia (excess bilirubin in the blood) in newborns. It occurs when bilirubin levels remain elevated for an extended period, leading to bilirubin crossing the blood-brain barrier and causing damage to the brain.

**Why the Correct Answer is Right:** The correct answer (D. Seizures) is excluded because seizures are an early manifestation of kernicterus, typically occurring within the first 2 weeks of life. Late features usually present after the first two weeks. Drowsiness and lethargy (A), decreased reflexes (B), and motor weakness (C) are considered late features, presenting after the first two weeks of life.

**Why Each Wrong Option is Incorrect:**

A. Drowsiness and lethargy: These symptoms are early manifestations of kernicterus, appearing within the first two weeks of life.
B. Decreased reflexes: Reflexes can be affected in kernicterus, particularly the Babinski reflex, which is often present in early kernicterus but is not a late feature.
C. Motor weakness: Motor weakness is a late feature of kernicterus, often developing after the first two weeks of life.

**Clinical Pearl:** Early recognition and management of severe hyperbilirubinemia in newborns is crucial to prevent kernicterus and its neurological complications. Regular bilirubin monitoring and appropriate phototherapy are essential in preventing kernicterus.

**Correct Answer:** D. Seizures are not part of the late features of kernicterus, as they typically present in the first two weeks of life.