PEDIATRICS Vol. 89 No. 5 May 1992, pp. 829-831
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Yet Another Expert Opinion on Bilirubin Toxicity!

LOIS JOHNSON MD1

1 Clinical Professor of Pediatrics, University of Pennsylvania, School of Medicine, Pennsylvania Hospital, Newborn Pediatrics, 800 Spruce Street, Philadelphia, Pennsylvania, 19107

Drs Newman and Maisels1 have provided valuable new guidelines for management of jaundice in the term newborn which take into account age at discharge from the hospital and some of the factors altering the general risk of bilirubin toxicity. They note that much of the information needed to identify the individual at risk is still unavailable and remind their readers that their "recommendations should be reevaluated periodically as new data become available."

I have serious concerns, however, with the second half of their paper which almost completely downplays the toxic potential of bilirubin, its often erratic expression, and its ability to cause a spectrum of damage ranging from frank kernicterus to insults that are so minor as to be compensated for completely over time.2-4

Submitted on February 13, 1992
Accepted on February 14, 1992




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