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Comment & Response
October 7, 2019

Avoiding Harm From Hyperbilirubinemia Screening

Author Affiliations
  • 1Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Department of Pediatrics, Beaumont Children’s Hospital, Oakland University William Beaumont School of Medicine, Rochester, Michigan
JAMA Pediatr. 2019;173(12):1209. doi:10.1001/jamapediatrics.2019.3765

To the Editor It was with great interest and some alarm that we read the Grosse et al Viewpoint entitled “Screening for Neonatal Hyperbilirubinemia: First Do No Harm?”1 The authors assert that the “relevant question for screening policy and practice is the balance of benefits and harms associated with treatments after screening,”1 an appropriate concern. We have other concerns about neonatal jaundice. Screening for hyperbilirubinemia serves an important purpose beyond identifying infants who might require treatment, namely, identifying those who are at risk for developing subsequent severe hyperbilirubinemia. Surely the authors do not suggest forgoing jaundice screening, the minimum standard of care for decades in identifying hyperbilirubinemia in neonates? Unfortunately, the clinical diagnosis of jaundice in infants who are younger than 48 hours is simply too imprecise to allow a judgment regarding the need for additional investigation, intervention, or timely follow-up,2 and we now have much more robust, noninvasive bilirubin screening available, such as transcutaneous bilirubin measurement. The issue Grosse et al1 raise is how to act on the screening result, something the 2009 American Academy of Pediatrics updated guideline sets forth in detail.3 In this regard, raising phototherapy treatment thresholds4 will necessitate more vigilant bilirubin surveillance, not less.

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