2 Neuro-Developmental Outcomes at 18 Months Corrected Age in Infants Weighing <1500 Grams Enrolled in a Randomized Trial of Agressive Versus Conservative Phototherapy
Notice bibliographique
Résumé
The “safe” level of serum bilirubin in infants <1500 grams is controversial, but recent retrospective reviews show direct correlation between peak bilirubin level and adverse neuro-developmental outcome. Our recent randomized study showed that infants <1000 grams who received conservative phototherapy had higher peak bilirubin levels and that infants <1500 grams who received conservative phototherapy reached peak bilirubin levels earlier than those treated with aggressive phototherapy. The purpose of this study was to examine the 18 month neuro-developmental outcomes in infants <1500 grams who had been enrolled in our randomized trial of aggressive versus conservative phototherapy. This follow-up phase of an unmasked, randomized study included infants with birth weight <1500 grams who had no evidence of major anomaly or iso-immunization and for whom parental consent was obtained. Aggressive phototherapy was started by 12 hours of post-natal age, while conservative phototherapy was started when the serum bilirubin level exceeded 8.8 mg/dL (150 μmol/L). All surviving infants were enrolled in a comprehensive neuro-developmental follow-up program at 4, 8, 12, 18, 14 and 36-months corrected age. At each visit, a full neuro-developmental assessment was performed and information on growth, hospital readmission, interval health and medication use was collected. All children had hearing screens at the 12-month visit, regular vision screening, and Bayley Scales of Infant Development (BSID-III) at the 18 and 36 month visits, if cooperative. Of 95 patients enrolled in the original study, 87 (92%) survived until hospital discharge, of whom 82 (94% of survivors) attended for comprehensive neuro-developmental assessment until 12 months corrected age and 75 (86% of survivors) attended until 18 months corrected age. The incidence of cerebral palsy was higher in the conservative phototherapy group 7/41 (17%) vs 2/41 (5%), p=0.15, OR 4.01 [0.69, 41.50]. The combined outcome of CP/death was also higher in the conservative group at 12/46 (26%) vs 5/44 (11%), p=0.04, OR 3.44 [0.92, 15.82]. Two-thirds of the infants with CP were in the <1000 grams subgroup. An MDI <84 on 18-month corrected age BSID-III testing did not differ between the two groups being 6/38 (16%) in the conservative group and 8/37 (22%) in the aggressive group, p=0.52, OR 0.68 [0.17, 2.56]. Although the numbers in this study are too small to draw definitive conclusions, there is a worrisome trend for poor neuro-developmental outcome for infants receiving conservative phototherapy, particularly in the <1000 grams group. Further studies with long-term neuro-developmental outcome as the primary outcome are urgently required.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».