Yeo K L, Perlman M, Hao Y, Mullaney P
Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatrics. 1998 Dec;102(6):1426-31. doi: 10.1542/peds.102.6.1426.
To analyze, in extremely low birth weight infants, associations between peak bilirubin concentration and evidence of brain damage, and between peak bilirubin concentration and blindness attributable to retinopathy of prematurity.
Retrospective study of 128 infants of </=800 g birth weight and </=27 weeks gestation born between 1980 and 1989 and discharged from a tertiary neonatal intensive care unit. After screening analyses, multivariable analyses were conducted to identify associations between blindness and peak bilirubin concentration (dichotomized at different levels to create 3 binary variables), and between severe adverse neurodevelopmental outcome at 18 months postterm age and peak bilirubin levels.
Of 128 18-month survivors, 15 had severe visual loss attributable to retinopathy of prematurity, 21 had neurodevelopmental deficit, and 5 were deaf. Visual loss was significantly associated with low-peak serum bilirubin concentration (<9.4 mg/dL (<160 micromol/L) versus >/=9.4 mg/dL (odds ratio [OR] confidence interval [CI] 4.48 [1.15-17.43])), low gestational age (OR [CI] per week 1.95 [1.05-3.63]), and longer duration of phototherapy (OR [CI] per 10 hours 1.17 [1.02-1.33]). The association of neurodevelopmental impairment with grades 3 and 4 intraventricular hemorrhage was statistically significant (OR 5.39 [1.83-15.84]), but with high-peak serum bilirubin concentration >/=11.7 mg/dL (>/=200 micromol/L), was not significant (OR 2.89 [0. 87-9.53]).
In these infants, prolonged phototherapy and low-peak serum bilirubin concentrations were associated with severe visual loss attributable to retinopathy of prematurity. The findings should be interpreted with caution until the evidence is reinforced in other patient populations.
分析极低出生体重儿中，胆红素峰值浓度与脑损伤证据之间的关联，以及胆红素峰值浓度与早产儿视网膜病变所致失明之间的关联。
对1980年至1989年间出生体重≤800克、孕周≤27周且从三级新生儿重症监护病房出院的128例婴儿进行回顾性研究。经过筛查分析后，进行多变量分析，以确定失明与胆红素峰值浓度（在不同水平进行二分法划分以创建3个二元变量）之间的关联，以及孕龄18个月时严重不良神经发育结局与胆红素峰值水平之间的关联。
在128例18个月存活者中，15例因早产儿视网膜病变出现严重视力丧失，21例有神经发育缺陷，5例失聪。视力丧失与低胆红素峰值浓度（<9.4mg/dL（<160μmol/L）与≥9.4mg/dL相比，优势比[OR]置信区间[CI]为4.48[1.15 - 17.43]）、低孕周（每孕周OR[CI]为1.95[1.05 - 3.63]）以及更长的光疗持续时间（每10小时OR[CI]为1.17[1.02 - 1.33]）显著相关。神经发育障碍与3级和4级脑室内出血的关联具有统计学意义（OR为5.39[1.83 - 15.84]），但与高胆红素峰值浓度≥11.7mg/dL（≥200μmol/L）的关联不显著（OR为2.89[0.87 - 9.53]）。
在这些婴儿中，长时间光疗和低胆红素峰值浓度与早产儿视网膜病变所致严重视力丧失相关。在其他患者群体中强化证据之前，对这些发现应谨慎解读。
