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.