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Comment & Response
October 7, 2019

Avoiding Harm From Hyperbilirubinemia Screening—Reply

Author Affiliations
  • 1National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Department of Health Management and Policy, University of Michigan, Ann Arbor
  • 3Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor
  • 4Department of Pediatrics, The University of Utah, Salt Lake City
JAMA Pediatr. Published online October 7, 2019. doi:10.1001/jamapediatrics.2019.3762

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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