Bilirubin Binding Tests: Living Up to Expectations?

In the management of jaundiced infants, the pediatrician is often confronted with the dilemma of whether or not to perform an exchange transfusion. Following the report,1 in 1952, that in infants with erythroblastosis fetalis kernicterus was frequent when total serum bilirubin concentrations exceeded 30 mg/dl but rare when less than 20 mg/dl, it became standard practice to perform an exchange transfusion upon elevation of serum bilirubin concentrations above 20 mg/dl. However, bilirubin encephalopathy has since been observed at serum bilirubin concentrations well below this critical level, ranging down to 9.4 to 14.0 mg/dl in sick, low birth weight premature infants.2-6