Departments of Epidemiology and Biostatistics,
Pediatrics, and.
Pediatrics. 2018 Oct;142(4). doi: 10.1542/peds.2018-0648.
: media-1vid110.1542/5804915133001PEDS-VA_2018-0648 BACKGROUND AND OBJECTIVES: In a recent Danish study, researchers found an increased risk of childhood epilepsy after phototherapy but only in boys. We investigated this association in a Kaiser Permanente Northern California cohort.
From 499 642 infants born at ≥35 weeks' gestation in 1995-2011 followed for ≥60 days, we excluded 1773 that exceeded exchange transfusion thresholds and 1237 with seizure diagnoses at <60 days. We ascertained phototherapy, covariates, and outcomes from electronic records and existing databases. Our primary outcome was ≥1 encounter with a seizure diagnosis plus ≥1 prescription for an antiepileptic drug. We used Cox and Poisson models to adjust for bilirubin levels and other confounding variables.
A total of 37 683 (7.6%) infants received any phototherapy. The mean (SD) follow-up time was 8.1 (5.2) years. The crude incidence rate per 1000 person-years of the primary outcome was 1.24 among phototherapy-exposed children and 0.76 among those unexposed (rate ratio: 1.63; 95% confidence interval [CI]: 1.44 to 1.85). The adjusted hazard ratio (aHR) was 1.22 (95% CI: 1.05 to 1.42; = .009). Boys were at higher risk of seizures overall (aHR = 1.18; 95% CI: 1.10 to 1.27) and had a higher aHR for phototherapy (1.33; 95% CI: 1.10 to 1.61) than girls (1.07; 95% CI: 0.84 to 1.37), although effect modification by sex was not statistically significant ( = .17). The adjusted 10-year excess risks per 1000 were 2.4 (95% CI: 0.6 to 4.1) overall, 3.7 (95% CI: 1.2 to 6.1) in boys, and 0.8 (95% CI: -1.7 to 3.2) in girls.
Phototherapy in newborns is associated with a small increased risk of childhood seizures, even after adjusting for bilirubin values, and the risk is more significant in boys.
在最近的一项丹麦研究中，研究人员发现光疗后儿童癫痫发作的风险增加，但仅在男孩中发现。我们在 Kaiser Permanente 北加利福尼亚队列中对此关联进行了调查。
在 1995 年至 2011 年间出生且胎龄≥35 周并至少随访 60 天的 499642 名婴儿中，我们排除了 1773 名胆红素超过换血阈值的婴儿和 1237 名在 60 天内诊断为癫痫发作的婴儿。我们从电子病历和现有数据库中确定光疗、协变量和结局。我们的主要结局是≥1 次癫痫发作诊断和≥1 次抗癫痫药物处方。我们使用 Cox 和 Poisson 模型调整胆红素水平和其他混杂变量。
共有 37683 名（7.6%）婴儿接受了任何光疗。平均（SD）随访时间为 8.1（5.2）年。暴露于光疗的儿童中主要结局的每 1000 人年发生率为 1.24，未暴露于光疗的儿童为 0.76（发生率比：1.63；95%置信区间[CI]：1.44 至 1.85）。调整后的危险比（aHR）为 1.22（95%CI：1.05 至 1.42； =.009）。总体而言，男孩的癫痫发作风险更高（aHR = 1.18；95%CI：1.10 至 1.27），且光疗的 aHR 也高于女孩（1.33；95%CI：1.10 至 1.61），尽管性别对治疗效果的影响没有统计学意义（ =.17）。每 1000 人 10 年的超额风险为 2.4（95%CI：0.6 至 4.1），男孩为 3.7（95%CI：1.2 至 6.1），女孩为 0.8（95%CI：-1.7 至 3.2）。
即使在调整胆红素值后，新生儿光疗与儿童癫痫发作的风险增加有关，且在男孩中风险更为显著。
Zotero 插件