We thank Dr Korsch for his insightful comments. The study cohort in which we developed and validated our prediction rule is younger than the one Dr Korsch describes. Of the infants in our cohort, 96.5% started their first inpatient phototherapy before age 5 days, and we agree that the prediction rule did not capture the probability of rebound hyperbilirubinemia in older infants who undergo their first inpatient phototherapy. For these older infants with significant weight loss, presumably once their feeding difficulties are resolved, their probability of rebound hyperbilirubinemia would be low, although certainly not 0.
In addition, we agree with Dr Korsch that adequate feeding is an essential part of the treatment of hyperbilirubinemia. We do not believe, however, that a sufficient milk supply is necessary to apply the prediction rule. Given the young age of our study cohort (average age of 2.3 days at phototherapy initiation), it is likely that breastfeeding was not well established for many of these infants, and 70% of our cohort received at least 1 formula feeding during phototherapy hospitalization. The senior authors of this article are currently investigating weight loss and feeding in more detail as predictors of readmission for phototherapy.
CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- Copyright © 2017 by the American Academy of Pediatrics