Kernicterus Continues to Occur in the USA Despite Concerted Preventive Efforts.

Kernicterus spectrum disorder continues to occur in the USA, even after improvements in detecting and managing hyperbilirubinemia were brought about by the 2022 AAP revised guidelines. Three of eight new cases of kernicterus occurring in our state during the past 15 years were infants who were intentionally born at home following a low-risk term pregnancy where the AAP guidelines were not applied. Considering the number of births per year in each setting, infants born at home are 7 times more likely to develop kernicterus than infants born in a hospital. Herein, we report our most recent case. We then provide a practical recommendation for averting future cases of kernicterus following out-of-hospital births. Specifically, we recommend that hospital systems and/or health departments supply all midwives performing out-of-hospital births with the equipment and training necessary to comply with the AAP guidelines by quantitatively assessing hyperbilirubinemia on every neonate 24-48 h following birth. We propose that this noninvasive, simple, and rapid assessment should be free of charge to the midwife and to the family. We maintain that if this is done routinely after every out-of-hospital birth, it will identify the neonates who need phototherapy and who sometimes also need other medical care to prevent extreme hyperbilirubinemia. We believe that such a program will prevent acute bilirubin encephalopathy and kernicterus and that without such a program, the dreadful condition of kernicterus spectrum disorder will continue to occur among our population of infants born at home.