The challenge of preventing neonatal bilirubin encephalopathy: a new nursing protocol in the well newborn nursery.

Jaundice is common in healthy newborn infants. It is the result of normal adaptive physiological processes and generally peaks in severity between 3 and 5 days after birth and then resolves over the next 7 to 10 days. When bilirubin rises to toxic levels, bilirubin encephalopathy and subsequent kernicterus can occur. Phototherapy is a well-established and safe treatment of neonatal jaundice. A recent increase nationwide in the number of infants with kernicterus has made prevention of severe hyperbilirubinemia a national priority. Clinical estimation of jaundice severity is notoriously inaccurate. This fact coupled with early discharge of newborns, often before bilirubin levels have peaked, makes hospital-based risk assessment an essential intervention before discharge.