Kernicterus in term and near-term infants--the specter walks again

Diagnostic and therapeutic intervention is common in newborns with neonatal jaundice, motivated by the fear of bilirubin-associated brain damage, kernicterus. In recent years, a resurgence of kernicterus has been noted in countries in which this complication had essentially disappeared. Both early postnatal discharge and relaxation of attitudes to neonatal jaundice have been implicated. Guidelines for the management of neonatal jaundice show significant disparity, attesting to our inadequate understanding of the underlying biology. Aggressive guidelines expose infants to unnecessary risks, risks that are significant when it comes to exchange transfusion, and may also involve improper use of limited resources. Relaxed guidelines, on the other hand, may expose infants to increased risk of brain toxicity.

At present we have no tools for ensuring certain identification of individuals with increased vulnerability to bilirubin toxicity. Relaxation of guidelines which have been proven safe through prolonged use should therefore be undertaken only in an atmosphere of increased vigilance. Guidelines that allow for a range of therapeutic and diagnostic options underline the need for careful assessment of each case on its individual merits.