Is phototherapy exposure associated with better or worse outcomes in 501- to 1000-g-birth-weight infants?
To compare risk-adjusted outcomes at 18- to 22-month-corrected age for extremely low birth weight (ELBW) infants who never received phototherapy (NoPTx) to those who received any phototherapy (PTx) in the NICHD Neonatal Research Network randomized trial of Aggressive vs. Conservative Phototherapy. Methods:
Outcomes at 18 to 22-month-corrected age included death, neurodevelopmental impairment (NDI) and Bayley Scales Mental Developmental Index (MDI). Regression models evaluated the independent association of PTx with adverse outcomes controlling for centre and other potentially confounding variables. Results:
Of 1972 infants, 216 were NoPTx and 1756 were PTx. For the entire 501- to 1000-g-BW cohort, PTx was not independently associated with death or NDI (OR 0.85, 95% CI: 0.60–1.20), death or adverse neurodevelopmental endpoints. However, among infants 501–750 g BW, the rate of significant developmental impairment with MDI < 50 was significantly higher for NoPTx (29%) than PTx (12%) (p = 0.004). Conclusions:
Phototherapy did not appear to be independently associated with death or NDI for the overall ELBW group. Whether PTx increases mortality could not be excluded because of bias from deaths before reaching conservative treatment threshold. The higher rate of MDI < 50 in the 501- to 750-g-BW NoPTx group is concerning and consistent with NRN Trial results.
Document Type: Research Article
Affiliations: 1: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA 2: Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA 3: Statistics and Epidemiology Unit, RTI International, Rockville, MD, USA 4: Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA 5: Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RI, USA 6: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA 7: Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA 8: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
Publication date: July 1, 2011