<p>Despite growing concerns about the adverse effects of painful procedures in neonates, current guidelines continue to recommend using total serum bilirubin (TSB) levels to make decisions in the treatment of hyperbilirubinemia. Transcutaneous bilirubin assessment (TcB) has been studied extensively, but its presumed reliability is only based on how well it correlates with TSB. This assumes that TSB is the “gold standard” for determining the risk of bilirubin-induced neurotoxicity, although there is no direct evidence linking specific TSB levels to that risk. Furthermore, TSB levels are subject to variability due to the margin of error of the laboratory analysis. TcBs avoid skin-breaking procedures and have the additional advantages of decreased turn-around time, nursing and laboratory staff time, and costs. TcB procedures could be standardized, and new guidelines with increased reliance on them could significantly reduce painful procedures in these patients without increasing the risk of bilirubin neurotoxicity.</p>