The authors thank Dr Manzar for the interest in and comments about our study, which raise several points worthy of further discussion.

Although the phototherapy nomogram (American Academy of Pediatrics hyperbilirubinemia guideline, Fig 3) does provide riskstratified treatment thresholds at the sixth hour, there is a notation that “these guidelines are based on limited evidence and the levels shown are approximations.” The studies that contributed to these approximations primarily focused on identifying high-risk newborns before discharge, with bilirubin measurements most often after 24 hours. The well-known study that generated the Bhutani nomogram excluded newborns who were direct antiglobulin test (DAT) positive and only reported on total serum bilirubin measurements (TSB), not transcutaneous bilirubin (TcB). The average TSB in this study was 34 hours with few measurements <18 hours and no TSB measurements <12 hours. Therefore, the reliability of the approximations in Fig 3 is lower in the...

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