临床状况对极低出生体重儿血浆总胆红素和未结合胆红素与死亡或不良神经发育结局之间关系的影响。
Influence of clinical status on the association between plasma total and unbound bilirubin and death or adverse neurodevelopmental outcomes in extremely low birth weight infants.
机构信息
Warren Alpert Medical School of Brown University, RI, USAStanford University, Palo Alto, CAUniversity of Texas, Houston, TX, USAZF Diagnostics Vashon, WA, USAResearch Triangle International, RTI, NC, USAUniversity of Rochester, Rochester, NY, USAWake Forest University Winston-Salem, NC, USANICHD, Bethesda, MD, USA.
出版信息
Acta Paediatr. 2010 May;99(5):673-678. doi: 10.1111/j.1651-2227.2010.01688.x. Epub 2010 Jan 25.
OBJECTIVES
To assess the influence of clinical status on the association between total plasma bilirubin and unbound bilirubin on death or adverse neurodevelopmental outcomes at 18-22 months corrected age in extremely low birth weight infants.
METHOD
Total plasma bilirubin and unbound bilirubin were measured in 1101 extremely low birth weight infants at 5 +/- 1 days of age. Clinical criteria were used to classify infants as clinically stable or unstable. Survivors were examined at 18-22 months corrected age by certified examiners. Outcome variables were death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss, and death prior to follow-up. For all outcomes, the interaction between bilirubin variables and clinical status was assessed in logistic regression analyses adjusted for multiple risk factors.
RESULTS
Regardless of clinical status, an increasing level of unbound bilirubin was associated with higher rates of death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss and death before follow-up. Total plasma bilirubin values were directly associated with death or neurodevelopmental impairment, death or cerebral palsy, death or hearing loss, and death before follow-up in unstable infants, but not in stable infants. An inverse association between total plasma bilirubin and death or cerebral palsy was found in stable infants.
CONCLUSIONS
In extremely low birth weight infants, clinical status at 5 days of age affects the association between total plasma bilirubin and death or adverse neurodevelopmental outcomes at 18-22 months of corrected age. An increasing level of UB is associated a higher risk of death or adverse neurodevelopmental outcomes regardless of clinical status. Increasing levels of total plasma bilirubin are directly associated with increasing risk of death or adverse neurodevelopmental outcomes in unstable, but not in stable infants.
目的
评估临床状况对极低出生体重儿血浆总胆红素和未结合胆红素与 18-22 个月校正年龄时死亡或不良神经发育结局之间关联的影响。
方法
在 1101 名极低出生体重儿出生后 5 ± 1 天内测量血浆总胆红素和未结合胆红素。根据临床标准将婴儿分为临床稳定或不稳定。幸存者在 18-22 个月校正年龄时由认证检查者进行检查。所有结局变量均为死亡或神经发育障碍、死亡或脑瘫、死亡或听力损失以及随访前死亡。在调整了多个危险因素的逻辑回归分析中，评估了胆红素变量与临床状况之间的相互作用。
结果
无论临床状况如何，未结合胆红素水平的升高与死亡或神经发育障碍、死亡或脑瘫、死亡或听力损失以及随访前死亡的发生率较高相关。不稳定婴儿的血浆总胆红素值与死亡或神经发育障碍、死亡或脑瘫、死亡或听力损失以及随访前死亡直接相关，但稳定婴儿则没有。在稳定婴儿中，发现血浆总胆红素与死亡或脑瘫之间存在负相关。
结论
在极低出生体重儿中，出生后 5 天的临床状况影响血浆总胆红素与 18-22 个月校正年龄时死亡或不良神经发育结局之间的关联。未结合胆红素水平的升高与死亡或不良神经发育结局的风险增加有关，无论临床状况如何。在不稳定的婴儿中，血浆总胆红素水平的升高与死亡或不良神经发育结局的风险增加直接相关，但在稳定的婴儿中则没有。
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