In Reply We appreciate the passion and commitment of Watchko and Maisels to the detection and treatment of neonatal hyperbilirubinemia (NBH) and jaundice. We understand their concern that our Viewpoint calls attention to evidence of a potential long-term harm of phototherapy: increased risk of epilepsy.1 Advocates often focus exclusively on benefits of screening and treatments. In contrast, it is the responsibility of policy makers to balance trade-offs between benefits and harms. Because the primary justification for screening and treatment for NBH is the prevention of kernicterus as a devastating long-term outcome, our Viewpoint focused on long-term health outcomes and did not attempt to catalog short-term harms or benefits of phototherapy.1 We realized that phototherapy is associated with a significantly lower need for exchange transfusions,2 which we considered a short-term benefit of treatment to reduce serum bilirubin levels.
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Grosse SD, Prosser LA, Botkin JR. Avoiding Harm From Hyperbilirubinemia Screening—Reply. JAMA Pediatr. Published online October 07, 2019. doi:10.1001/jamapediatrics.2019.3762
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