PURPOSE We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake. METHODS A review of literature was undertaken to define basic pr...

Background: Exchange transfusion (ET) for severe neonatal hyperbilirubinemia (SNH) is frequently undertaken in lowand middle-income countries (LMIC), in sharp contrast to the prevailing practice in high-income countries. However, the criteria for initiating this procedure in settings with limited resources for treating infants with SNH have not been systematically explored. Objective: To identi...

Background. Severe hyperbilirubinaemia requiring exchange transfusion has become less common in recent years; however, kernicterus still occurs. The aim of this study was to review babies undergoing exchange transfusion for severe hyperbilirubinaemia in a Johannesburg hospital. Methodology. This was a retrospective review of babies who required exchange transfusion in both the neonatal and the ...

Dhaded et al.(1) have recommended a cut-off level of 20 mg/dl for exchange transfusion in term babies with nonhemolytic jaundice. This is based on their observations that 21 out of 86 (25.8%) babies with bilirubin level of more than 20 mg/dl developed kernicterus in their study group. It is well known that apart from bilirubin levels per se, many other factors determine bilirubin toxicity. As t...