Predicting bilirubin neurotoxicity in jaundiced newborns

Purpose of review The management of jaundice in the newborn infant is an area of clinical practice sorely lacking an evidence-based foundation, and neonatal bilirubin neurotoxicity (kernicterus) continues to occur worldwide. Recent findings Studies suggest that measuring serum or plasma bilirubin binding, in particular the nonalbumin-bound or unbound bilirubin concentration (B-f), would improve jaundice management as it better predicts bilirubin neurotoxicity than the conventionally used total bilirubin concentration (B-T). However, many misconceptions persist regarding the relationships between B-T, B-f, the magnitude and distribution of the neonatal bilirubin load, and the risk of bilirubin neurotoxicity. Summary Overcoming these misconceptions and integrating B-f and B-T into the management of neonatal jaundice may help move clinical practice from its tradition-based approach centered primarily on B-T toward an evidence-based approach that will substantially improve our ability to predict bilirubin neurotoxicity and improve the clinical management of this generally benign, but potentially catastrophic, newborn condition.