Post-kernicteric syndrome

Traditionally, neonates in Australia received specialised care in hospitals for about a week, by which time any developing jaundice would have been detected and managed. However, with the introduction and popularity of early maternal discharge about 48 hours after delivery (in Australia and elsewhere), the duty of diagnosing neonatal jaundice and referring newborns for urgent management falls on general practitioners. Delays or nonreferrals predispose infants to kernicterus or bilirubin encephalopathy, a previously uncommon cause of brain damage. In the interest of patient safety, family physicians need clinical guidelines for managing jaundice, as kernicterus is a preventable tragedy--and increasingly reported in journals. Until guidelines are available, hopefully this cautionary tale will assist GPs in the risk management of all jaundiced infants.