In Reply.—

It is difficult to measure small concentrations of direct-reacting bilirubin accurately, particularly in the presence of significant indirect hyperbilirubinemia.1 Dr Pleasure's report draws attention to an important issue that has plagued us for many years, and it is distressing to note that there is little evidence that the situation has improved significantly during the last three decades.2-4

Two recent surveys disclosed high levels of interlaboratory variation in the measurements of total and direct serum bilirubin concentrations in neonatal sera.3,4

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