Evidence of bilirubin-related brain damage has been reported in infants with kernicterus discharged as healthy from well-baby nurseries. Lapses in care have been attributed as root causes for kernicterus in an era when there should be no barriers to safe and effective bilirubin reduction strategies. Between 1984 and 2002, at least 125 cases of kernicterus occurred in the United States. This may be an underestimate because kernicterus is not a reportable condition in this country. In almost all cases, kernicterus is a preventable condition. The updated 2004 American Academy of Pediatrics guidelines recommend a systems approach, which, if implemented by all birthing institutions, should prevent virtually all cases of kernicterus in term and near-term infants.