Starting in the 1950s through the 1980s, clinical practice has evolved to essentially eliminate classic kernicterus. Great strides have been made in the management of neonatal jaundice, hyperbilirubinemia, and prevention of kernicterus over the past 25 years. The American Academy of Pediatrics practice parameter on the management of jaundice, published in 2004 and updated in 2009, marked a shift in clinical practice that initially resulted in a large decrease in the number of children developing kernicterus. However, a reemergence of kernicterus occurred in recent years and continues to the present. This has been associated with changes in medical practice and health care delivery. Importantly, universal screening of infants combined with close follow-up, monitoring, and aggressive phototherapy treatment at relatively low bilirubin levels could eliminate most of the new cases of kernicterus, but the prevention of a devastating but very rare disorder must be balanced against the costs and possible risks of overtreating a very large numbers of infants. Determining the bilirubin level at which toxicity is increased is a difficult issue for physicians in everyday practice. This must be balanced against the gains of an early visit versus the concerns that increased surveillance will result in a greater use of resources (phototherapy), more parental anxiety, and reduced breastfeeding. Gaps in knowledge persist, including the neurotoxic impact of hyperbilirubinemia in preterm infants, and the potential importance of genomic susceptibility to bilirubin neurotoxicity.

Multifunctional calcium and calmodulin-dependent kinase II in neuronal function and disease

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