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Key Points   Question  What is the incidence of hazardous neonatal hyperbilirubinemia, and does an association exist between the quality of neonatal care and kernicterus?    Findings  In this population-based cohort study of 992 378 live-born children in Sweden from 2008 to 2016, 67 newborns were exposed to serum bilirubin levels of 30 mg/dL (510 μmol/L) or higher, of whom 13 developed kernicterus. Root cause analysis indicated that 11 of these 13 kernicterus cases (85%) were potentially avoidable because they were associated with suboptimal screening, diagnosis, or treatment.    Meaning  Kernicterus observed in a high-resource setting was associated with nonadherence to best practice guidelines and thus might have been prevented in a majority of infants.

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Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden