Neonatologists still see occurrences of kernicterus and reports in the literature (124,133,328,329,390,406) suggest a “resurgence” of this devastating condition. Neverthe-less, there are no appropriate data to support this perception, because there is no uniform surveillance for the reporting of kernicterus over the last 3 to 4 decades, no agreed on case definition for kernicterus, and, most important, no denominators (i.e., population base) for the case reports listed. Nevertheless, the fact that kernicterus, although rare, still occurs, demands our attention because it is nearly always preventable by relatively simple interventions (76).

A preliminary analysis of the reported cases of kernicterus suggests the possible root causes (124,407) listed in Table 35-23.

In addition to the global trend toward a shorter hospital stay for newborns, several studies (239,241,288) but not all (206,408), have found that early discharge itself is associated with an increased risk of significant hyperbilirubinemia and even kernicterus (124,328). Recognizing both the risk of unrecognized jaundice in infants discharged early, as well as the fact that, in infants discharged before 72 hours, the TSB level is almost always still rising, the AAP guidelines for followup of infants discharged before 72 hours are stringent (76) (see section on Preventing Extreme Hyperbilirubinemia and Kernicterus).