ABSTRACT
BACKGROUND AND OBJECTIVE: High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. METHODS: In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. RESULTS: Composite motor (100 ± 13 vs. 101 ± 12) and cognitive (101 ± 12 vs. 101 ± 11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤ 1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g. CONCLUSIONS: The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN74465643.
Subject(s)
Bilirubin/analysis , Hyperbilirubinemia, Neonatal/blood , Hyperbilirubinemia, Neonatal/therapy , Kernicterus/prevention & control , Serum Albumin/analysis , Birth Weight , Female , Humans , Infant, Newborn , Infant, Premature , Male , Phototherapy , Prospective StudiesABSTRACT
BACKGROUND: The quality of very preterm infants' spontaneous movements at 11 to 16 weeks post-term age is a powerful predictor of their later neurological status. This study investigated whether early spontaneous movements also have predictive value for the intellectual and behavioural problems that children born very preterm often experience. METHODS: Spontaneous movement quality was assessed, using Prechtl's method, at 11 to 16 weeks post-term in 65 infants born at Subject(s)
Brain Damage, Chronic/diagnosis
, Child Behavior Disorders/diagnosis
, Infant, Premature, Diseases/diagnosis
, Intelligence
, Learning Disabilities/diagnosis
, Motor Activity
, Attention Deficit Disorder with Hyperactivity/diagnosis
, Attention Deficit Disorder with Hyperactivity/psychology
, Brain Damage, Chronic/psychology
, Bronchopulmonary Dysplasia/diagnosis
, Bronchopulmonary Dysplasia/psychology
, Cerebral Hemorrhage/diagnosis
, Cerebral Hemorrhage/psychology
, Cerebral Ventricles
, Child
, Child Behavior Disorders/psychology
, Child, Preschool
, Early Diagnosis
, Female
, Humans
, Infant
, Infant, Newborn
, Infant, Premature, Diseases/psychology
, Intensive Care Units, Neonatal
, Internal-External Control
, Learning Disabilities/psychology
, Leukomalacia, Periventricular/diagnosis
, Leukomalacia, Periventricular/psychology
, Longitudinal Studies
, Male
, Mass Screening
, Neurologic Examination
, Predictive Value of Tests
, Prognosis
, Respiration, Artificial
, Vestibular Neuronitis