Bilirubin and Brain Damage— A Real Mess

Abstract

What to do for the low-birth-weight jaundiced neonate has been a subject of debate for 30 years. It is generally agreed that the "20 mg/100 ml level" for an exchange transfusion in a full-term infant with hemolytic disease, has been effective in avoiding deaths due to kernicterus and brain damage due to bilirubin neurotoxicity. It's not perfect, but it has been effective. This is amazing because the original studies, judged by modern standards, would not be acceptable today.1 Trouble first began when this concept was extended to jaundiced low-birth-weight infants. It was assumed that "the level" should be lower in smaller infants.