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, kern icterus. In recent years, a resurgence of kernicterus has been noted in cou ntries in which this complication had essentially disappeared. Both early p ostnatal discharge and relaxation of attitudes to neonatal jaundice have be en implicated. Guidelines for the management of neonatal jaundice show sign ificant disparity, attesting to our inadequate understanding nf thp underly ing biology. aggressive guidelines expose infants to unnecessary risks, ris ks that are significant when it comes to exchange transfusion, and may also involve improper use of limited resources. Relaxed guidelines, on the othe r hand, may expose infants to increased risk of brain toxicity. Conclusion: At present we have no tools for ensuring certain identification of individuals with increased vulnerability to bilirubin toxicity. Relaxat ion of guidelines which have been proven safe through prolonged use should therefore be undertaken only in an atmosphere of increased vigilance. Guide lines that allow for a range of therapeutic and diagnostic options underlin e the need for careful assessment of each case on its individual merits.