Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more
Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more
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DOI：
10.1056/nejmoa054244
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发表时间：
2006-05-04
影响因子：
158.5
通讯作者：
Escobar, GJ
中科院分区：
文献类型：
--
作者：
Newman, TB;Liljestrand, P;Escobar, GJ
背景：与新生儿高血清总胆红素水平相关的神经发育风险尚未明确。方法：我们从1995年至1998年在加利福尼亚北部Kaiser Permanente医院出生的106627名足月和近期婴儿中随机选择了140名新生儿血清总胆红素水平至少为25毫克/分升（428微mol /升）的婴儿和419名对照。结果数据来自电子记录、访谈、问卷回答和以盲法进行的神经发育评估。结果：130例高胆红素血症新生儿的峰值胆红素水平在25 - 29.9 mg /分升（511微摩尔/升）之间，10例新生儿的峰值胆红素水平在30 mg /分升（513微摩尔/升）或更高；治疗包括光疗136例，换血5例。140名有高胆红素血症病史的儿童中有132名（94%）和419名对照中的372名（89%）可获得至少2岁的随访数据，包括82名儿童（59%）和168名儿童（40%）的平均（+/-SD）年龄为5.1+/-0.12岁的正式评估。无核黄疸病例。两组之间的认知测试的粗糙分数和调整分数都没有显著差异；在大多数测试中，95%的置信区间排除了高胆红素血症组调整得分3点（0.2 SD）的下降。在体格检查中发现神经系统异常的儿童比例或有神经系统异常诊断的儿童比例在两组之间没有显著差异。高胆红素血症患儿中有14例（17%）在神经系统检查中有“可疑”或异常的发现，而对照组有48例（29%；P=0.05；校正优势比为0.47；95%可信区间为0.23 ~ 0.98；P=0.04）。父母关心的频率和报告的行为问题在两组之间也没有显著差异。在高胆红素血症组中，直接抗球蛋白测试呈阳性的患者在认知测试中得分较低，但没有出现更多的神经或行为问题。结论：当接受光疗或换血治疗时，本研究范围内的血清总胆红素水平与足月或足月新生儿的不良神经发育结局无关。
BACKGROUND:The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined.METHODS:We identified 140 infants with neonatal total serum bilirubin levels of at least 25 mg per deciliter (428 micromol per liter) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants born from 1995 through 1998 in Kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records, interviews, responses to questionnaires, and neurodevelopmental evaluations that had been performed in a blinded fashion.RESULTS:Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 micromol per liter) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter (513 micromol per liter) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in 5. Follow-up data to the age of at least two years were available for 132 of 140 children with a history of hyperbilirubinemia (94 percent) and 372 of 419 controls (89 percent) and included formal evaluation at a mean (+/-SD) age of 5.1+/-0.12 years for 82 children (59 percent) and 168 children (40 percent), respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests, 95 percent confidence intervals excluded a 3-point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia (17 percent) had ``questionable'' or abnormal findings on neurologic examination, as compared with 48 controls (29 percent; P=0.05; adjusted odds ratio, 0.47; 95 percent confidence interval, 0.23 to 0.98; P=0.04). The frequencies of parental concern and reported behavioral problems also were not significantly different between the two groups. Within the hyperbilirubinemia group, those with positive direct antiglobulin tests had lower scores on cognitive testing but not more neurologic or behavioral problems.CONCLUSIONS:When treated with phototherapy or exchange transfusion, total serum bilirubin levels in the range included in this study were not associated with adverse neurodevelopmental outcomes in infants born at or near term.