Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

The clinical effect of early intervention on very low birth weight premature infants / 实用医学杂志

Objective To explore the influence of early intervention on physical and intelligent development of premature infants with very low birth weight. Methods Selected 32 premature infants of very lowbirth weight treated in neonatal intensive care unit during November 2011 to October 2012 as the intervention group. To avoid the violation of medical ethics, we select another 32 premature infants with very low birth weight who were born before November 2011and aged between 9 to 15 months as the control group. The intervention group was treated with early intervention, including regular physical development evaluation, neuromotor examination and test of intelligence. The intervention group was followed-up until correction age of 1 year and the control group was only at the year of correction age of 1 year. Results The physical development in the intervention group was better than the control group at the age of 1, the mental development index (MDI) and psychomotor development index (PDI) significantly higher than those of the control group as well. The incidences of low intelligence and cerebral palsy were lower than those of the control group. The differences were statistically significant. Conclusion Early intervention is obviously effective in promoting the physical and intelligent development of very low birth weight premature infants, reducing the incidence of low intelligence and cerebral palsy, and improving the long-term living quality of the survivors. Still, the method centers on family, and therefore, is feasible and effective. So the doctors for children′s care from basic hospitals should vigorously promote the method.