Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Integrated Neonatal Perinatal Fellowship Program, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
J Pediatr. 2023 Aug;259:113458. doi: 10.1016/j.jpeds.2023.113458. Epub 2023 May 11.
To describe the distribution of peak bilirubin levels among infants born before 29 weeks of gestation in the first 14 days of life and to study the association between quartiles of peak bilirubin levels at different gestational ages and neurodevelopmental outcomes.
Multicenter, retrospective, nationwide cohort study of neonatal intensive care units in the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network, including neonates born preterm at 22 to 28 weeks of gestation born between 2010 and 2018. Peak bilirubin levels were recorded during the first 14 days of age. Main outcome was significant neurodevelopmental impairment, defined as cerebral palsy with Gross Motor Function Classification System ≥3, or Bayley III-IV scores of <70 in any domain, or visual impairment, or bilateral hearing loss requiring hearing aids.
Among 12 554 included newborns, median gestational age was 26 weeks (IQR 25-28) and birth weight was 920 g (IQR 750-1105 g). The median peak bilirubin values increased as gestational age increased (112 mmol/L [6.5 mg/dL] at 22 weeks and 156 mmol/L [9.1 mg/dL] at 28 weeks). Significant neurodevelopmental impairment was identified in 1116 of 6638 (16.8%) of children. Multivariable analyses identified an association between peak bilirubin in the highest quartile and neurodevelopmental impairment (aOR 1.27, 95% CI 1.01-1.60) and receipt of hearing aid/cochlear implant (aOR 3.97, 95%CI: 2.01-7.82) compared with the lowest quartile.
In this multicenter cohort study, peak bilirubin levels in neonates of <29 weeks of gestation increased with gestational age. Peak bilirubin values in the highest gestational age-specific quartile were associated with significant neurodevelopmental and hearing impairments.
描述 29 周前出生的婴儿在出生后 14 天内胆红素峰值水平的分布，并研究不同胎龄时胆红素峰值四分位与神经发育结局之间的关系。
这是一项多中心、回顾性、全国性的加拿大新生儿网络和加拿大新生儿随访网络新生儿重症监护病房队列研究，包括 2010 年至 2018 年期间 22 至 28 周早产儿。在出生后 14 天内记录胆红素峰值水平。主要结局是出现显著的神经发育障碍，定义为脑瘫伴粗大运动功能分类系统≥3 级，或贝利 III-IV 评分在任何领域均<70 分，或视力障碍，或双侧听力损失需戴助听器。
在纳入的 12554 名新生儿中，中位胎龄为 26 周（IQR 25-28），出生体重为 920 g（IQR 750-1105 g）。随着胎龄的增加，胆红素峰值中位数逐渐升高（22 周时为 112mmol/L[6.5mg/dL]，28 周时为 156mmol/L[9.1mg/dL]）。在 6638 名儿童中，有 1116 名（16.8%）出现显著的神经发育障碍。多变量分析发现，最高四分位胆红素与神经发育障碍（aOR 1.27，95%CI 1.01-1.60）和接受助听器/人工耳蜗植入（aOR 3.97，95%CI：2.01-7.82）相关，与最低四分位相比。
在这项多中心队列研究中，<29 周胎龄新生儿的胆红素峰值水平随胎龄增加而增加。最高胎龄特定四分位的胆红素峰值与显著的神经发育和听力障碍相关。
