1 Mary Fletcher Hospital, Burlington, Vermont
Thank you for the opportunity to comment on the points brought up by Dr. Boggs in his letter.
First, I agree with Dr. Boggs that it is currently impossible to identify which infant with idiopathic hyperbilirubinemia (I would add, however, at whatever concentration of serum bilirubin) is at risk as far as kernicterus is cencerned.
Second, Dr. Boggs is again entirely correct in his belief that I would not endorse the approach of delayng treatment with exchange transfusion until one sees signs of early kernicterus. My intent was to point out that, as things now stand, one can only be absolutely certain that exchange transfusion is necessarily indicated in an individual case when the infant shows signs of early kernicterus, whatever the level of serum bilirubin may be, high or low.