ABSTRACT. Utilizing multicomponent spectrophotometry, we assayed the bilirubin content of rat cerebral hemispheres. With this assay, we determined the clearance of bilirubin from the rat brain following reversible, osmotic opening of the blood-brain barrier. Clearance was rapid, with a half-time of 1.7 h. This half-time was the same as that for clearance of bilirubin from the serum, suggesting that brain bilirubin was removed by transport or diffusion back into the general circulation. Hyperbilirubinemia is likely the most common medical diagnosis in the newborn. Physicians treat neonatal jaundice in order to prevent the neurotoxicity associated with brain uptake of bilirubin (kernicterus). Research on the cerebral transport and toxicity of bilirubin continues, but the results remain unclear (1). Uncertainty extends to clinical practice as well. For example, the preceding edition of Hospital Care of Newborn Infants, published by the American Academy of Pediatrics, included guidelines for exchange transfusion (2). The current edition omits guidelines, noting a diversity of approaches among physicians (3). In part, this diversity results from uncertainty about how bilirubin enters the brain and the anatomic and biochemical loci of bilirubin toxicity.The blood-brain bamer normally restricts exchange of watersoluble substances and proteins between blood and brain, but is damaged in diseases such as hypertension, by ischemia or trauma. Experimentally, the blood-brain bamer can be unilaterally and reversibly opened without causing brain damage by infusing a hypertonic solution of arabinose into one of the carotid arteries (4). Permeability returns to normal within about I h after arabinose infusion (5). We have previously shown that circulating albumin-bound bilirubin enters the side of the rat brain receiving the arabinose (4, 6). Furthermore, the regional cerebral distribution of albumin mimicks that seen in human kernicterus, providing a potential model for the human disease.We designed this study to determine the time-course of bilirubin entry into and removal from the brain after osmotic opening of the blood-brain bamer. For the study, we also developed rapid, simple techniques for the extraction and quantitation of bilirubin in brain tissue.