title: Vigintiphobia revisited.
abstract: In this review the historical tenets and evidence-based clinical research in support of a bilirubin exchange threshold of >20 mg/dL for the healthy term neonate are revisited. In addition, a hypothesis is ventured that recent cases of kernicterus are related in part to changes in population factors coupled with genetic predispositions that have unmasked an unappreciated potential for marked neonatal hyperbilirubinemia.
authors.affiliation: Division of Neonatology and Developmental Biology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. jwatchko@mail.magee.edu
authors.forename: Jon F
authors.initials: JF
authors.lastname: Watchko
mesh_terms: D000743:Anemia, Hemolytic / Q000097:blood / Q000150:complications / Q000628:therapy; D001663:Bilirubin / Q000097:blood*; D001942:Breast Feeding / Q000009:adverse effects; D003414:Crigler-Najjar Syndrome / Q000150:complications / Q000235:genetics; D003681:Dehydration / Q000150:complications; D003937:Diagnosis, Differential; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000150:complications / Q000235:genetics / Q000628:therapy; D005078:Exchange Transfusion, Whole Blood; D020022:Genetic Predisposition to Disease; D005878:Gilbert Disease / Q000150:complications / Q000235:genetics; D014453:Glucuronosyltransferase / Q000172:deficiency / Q000235:genetics; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D015994:Incidence; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000532:radiotherapy / Q000628:therapy; D007647:Kernicterus / Q000097:blood* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D009154:Mutation; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012203:Rh Isoimmunization; D014467:Ultraviolet Therapy; D014481:United States / Q000453:epidemiology; D000099148:UGT1A1 Enzyme
chemical_list: D001663:Bilirubin; D014453:Glucuronosyltransferase; D000099148:UGT1A1 Enzyme