Hyperbilirubinemia: should we adopt a new standard of care?

The review and recommendations by Newman and Maisels1 in this issue of Pediatrics constitute a provocative critique of our current state of knowledge concerning the risks of hyperbilirubinemia in term infants and should begin a dialogue about the recommended standard of care for jaundiced newborns. For several decades, the use of exchange transfusions to prevent kernicterus and phototherapy to prevent exchange transfusions, the puzzling emergence of low-bilirubin kernicterus, the "discovery" of breast milk jaundice, and concern over the possible contribution of bilirubin to neurologic handicap have combined to encourage preemptive intervention for moderate jaundice in asymptomatic newborns. But has this strategy of anticipatory management become hardened into an overly aggressive pattern of testing and treatment? Newman and Maisels conclude that it has.