Milner Joshua D, Aly Hany Z, Ward Laura B, El-Mohandes Ayman
Department of Pediatrics, Children's National Medical Center, Washington, DC, USA.
J Perinatol. 2003 Apr-May;23(3):208-11. doi: 10.1038/sj.jp.7210887.
Bilirubin is a potent in vitro antioxidant. Despite repeated study, its in vivo significance has yet to be defined. Bilirubin is universally elevated in very low birthweight (VLBW) infants. Retinopathy of prematurity (ROP) is a disease thought to be associated with exposure to oxygen free radicals in VLBW infants. The objective of this study was to determine whether there was an association between peak bilirubin levels and ROP.
The risk for ROP, stages III and IV was measured as a function of increasing peak bilirubin levels in VLBW infants admitted to the neonatal ICU. A similar analysis was performed on a subgroup of VLBW infants with prolonged (> or =28 days) oxygen requirement. The relation between peak bilirubin level and the duration of oxygen requirement was tested by logistic regression analysis. All analyses were conducted after controlling for birthweight and presence of intraventricular hemorrhage (IVH).
There was an increased risk for ROP, stages III and IV (OR 1.187; 95% CI 1.013 to 1.390; p=0.034) with elevated peak serum bilirubin levels in the entire population. Duration of oxygen requirement was not related to peak bilirubin (p>0.1). In the subgroup of infants with prolonged oxygen requirement (> or =28 days), there was no association between peak serum bilirubin levels and ROP III and IV (p>0.1); however, there was an association with further increased duration of oxygen requirement (p=0.034).
Elevated peak bilirubin does not protect from and may be a risk for ROP in VLBW infants.
胆红素是一种有效的体外抗氧化剂。尽管经过反复研究，但其在体内的意义仍未明确。极低出生体重（VLBW）婴儿的胆红素普遍升高。早产儿视网膜病变（ROP）被认为是一种与VLBW婴儿暴露于氧自由基有关的疾病。本研究的目的是确定胆红素峰值水平与ROP之间是否存在关联。
将入住新生儿重症监护病房的VLBW婴儿中ROP III期和IV期的风险作为胆红素峰值水平升高的函数进行测量。对氧需求延长（≥28天）的VLBW婴儿亚组进行了类似分析。通过逻辑回归分析测试胆红素峰值水平与氧需求持续时间之间的关系。所有分析均在控制出生体重和脑室内出血（IVH）的存在后进行。
在整个人口中，血清胆红素峰值升高会增加ROP III期和IV期的风险（OR 1.187；95%CI 1.013至1.390；p=0.034）。氧需求持续时间与胆红素峰值无关（p>0.1）。在氧需求延长（≥28天）的婴儿亚组中，血清胆红素峰值水平与ROP III期和IV期之间无关联（p>0.1）；然而，与氧需求持续时间进一步增加有关联（p=0.034）。
胆红素峰值升高并不能预防VLBW婴儿发生ROP，反而可能是其发生ROP的一个风险因素。
