GUIDELINES FOR MANAGEMENT OF THE JAUNDICED TERM AND NEAR-TERM INFANT

Factors believed to have contributed to the reemergence of kernicterus in the United States during the 1990's are discussed: these include d ecreased concern about toxicity of bilirubin in term and near-term inf ants, increased prevalence of breastfeeding, and increasingly shortene d postnatal hospital stays. The rationale for a universal predischarge bilirubin measurement at the time of the routine predischarge metabol ic screen is presented: the hour-specific level of bilirubin at discha rge, plotted on an Hour-Specific Bilirubin Nomogram, improves predicti on of risk of excessive jaundice postdischarge and facilitates safe, c ost-effective followup. This minimizes repeat bilirubin measurements a nd maximizes recognition of confounding variables and risk of hyperbil irubinemia so that timely, minimally invasive, preventive therapy can be instituted if needed.