The stir about kernicterus comes from a press release from JCAHO - for international folks, this is an accrediting agency for US hospitals and healthcare organizations.  They issued a "sentinel event" alert regarding kernicterus. You can find the info at their web site, www.jcaho.org   They basically urge hospitals to be more vigilant in detecting high bili levels.  It worries me to think of the prior bilirubin hypervigilance that we used to see making a come-back.  I was encouraged to see insufficient breastfeeding as one of the causes of jaundice.  Unfortunately, in the recommendations, there is nothing listed about improving breastfeeding support, or follow-up.  We have several peds who don't see infants for 2 weeks, regardless of discharge timing or breastfeeding competence.  I worry that if infants are not checked post discharge, and many are not, and hospitals are compelled by JCAHO to increase their vigilance regarding jaundice, that we will see a resurgence of interventions that interfere with breastfeeding instead of those which contribute to successful breastfeeding.  Hope I'm wrong -

Denise Sweeney, RN, IBCLC
Mobile, AL

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