What bilirubin level constitutes a panic value for kernicterus?

• A. >=20 mg/dL
• B. >=10 mg/dL
• C. >=5 mg/dL
• D. >=15 mg/dL

Answer: (A)

Kernicterus results when neurotoxic unconjugated bilirubin accumulates in the brain, which becomes more likely as the total bilirubin rises and the bilirubin–albumin binding capacity is overwhelmed. In newborns, especially term infants, clinicians use a panic (urgent) threshold to trigger rapid assessment and treatment to prevent bilirubin from causing neurological injury. A commonly referenced panic value for the risk of kernicterus is 20 mg/dL or higher, at which point urgent actions such as intensified phototherapy or exchange transfusion consideration are warranted depending on the infant’s age in hours and other risk factors. Lower levels may require monitoring or therapy, but they are not the same urgent threshold.