Although it has been customary to treat neonatal jaundice at lower serum bilirubin levels in low-birth weight infants than in term infants, the threshold bilirubin levels and long-term benefits for early treatment of preterm infants have not been validated. This article summarizes and evaluates existing evidence and strategies for early treatment of bilirubin in micropremies and recommends a conservative but flexible approach to early monitoring and phototherapy for jaundice in extremely low-birth weight infants.