A randomized trial of aggressive versus conservative phototherapy for hyperbilirubinemia in infants weighing less than 1500 g: Short- and long-term outcomes
Why this work is in the frame
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Bibliographic record
Abstract
Treatment regimens for hyperbilirubinemia vary for very low birth weight infants. The present study seeks to determine whether the initiation of conservative phototherapy is as effective as aggressive phototherapy in reducing peak bilirubin levels without increasing adverse effects. The present randomized, controlled study included infants with birth weights between 500 g and 1500 g, stratified into two birth weight groups. In one group, aggressive phototherapy was commenced by 12 h of age, while in the other group, conservative phototherapy was commenced if serum bilirubin levels exceeded 150 μmol/L. The primary outcome variables were peak serum bilirubin levels and hours of phototherapy. Secondary outcomes were age at peak bilirubin levels, number of infants with rebound hyperbilirubinemia, and number of adverse short- and long-term outcomes. Of 174 eligible infants, 95 consented to participate −49 in the conservative arm and 46 in the aggressive arm. Ninety-two infants completed the study. There was no significant difference in peak bilirubin levels except in infants who weighed less than 1000 g −171.2±26 μmol/L (conservative) versus 139.2±46 μmol/L (aggressive); P<0.02. There was no difference in duration of phototherapy or rebound hyperbilirubinemia. There were no differences in short-term adverse outcomes. Of the 87 infants who survived until hospital discharge, 82 (94%) had some follow-up and 75 (86%) attended follow-up until 18 months corrected age. The incidence of cerebral palsy, abnormal mental developmental index at 18 months corrected age, or combined outcome of cerebral palsy and death did not significantly differ between the two groups. In infants weighing less than 1000 g, peak bilirubin levels were significantly higher using conservative phototherapy regimens and there was a tendency for poor neurodevelopmental outcome. Les schémas thérapeutiques pour l'hyperbilirubinémie varient chez les nourrissons de très petit poids à la naissance. La présente étude vise à déterminer si l'initiation d'une photothérapie classique est aussi efficace qu'une photothérapie agressive pour réduire les taux de bilirubine de pointe sans accroître les effets indésirables. La présente étude aléatoire et contrôlée portait sur des nourrissons dont le poids de naissance variait entre 500 g et 1 500 g, stratifiés en deux groupes de poids à la naissance. La photothérapie agressive était entreprise avant 12 heures de vie, tandis que la photothérapie classique l'était si les taux de bilirubine sérique dépassaient 150 μmol/L. Les taux de bilirubine sérique de pointe et les heures de photothérapie étaient les variables d'issue primaire. Les issues secondaires étaient l'âge au taux de bilirubine de pointe, le nombre de nourrissons atteints d'une hyperbilirubinémie de rebond et le nombre d'issues négatives à court et à long terme. Des 174 nourrissons admissibles, 95 ont consenti à participer, soit 49 dans le volet classique et 46 dans le volet agressif. Quatre-vingt-douze nourrissons ont terminé l'étude. On n'a observé aucune différence significative des taux de bilirubine de pointe, sauf chez les nourrissons de moins de 1 000 g −171,2±26 μmol/L (volet classique) par rapport à 139,2±46 μmol/L (volet agressif); P<0,02. De plus, on n'a observé aucune différence dans la durée de la photothérapie, l'hyperbilirubinémie de rebond ou les issues négatives à court terme. Sur les 87 nourrissons qui ont survécu jusqu'au congé de l'hôpital, 82 (94 %) avaient eu un certain suivi et 75 (86 %) ont profité d'un suivi jusqu'à 18 mois d'âge corrigé. L'incidence d'infirmité motrice cérébrale, d'indice de développement mental anormal à 18 mois d'âge corrigé ou d'issue combinée d'infirmité motrice cérébrale et de décès ne différait pas de manière significative entre les deux groupes. Chez les nourrissons de moins de 1 000 g, les taux de bilirubine de pointe étaient considérablement plus élevés avec les schémas thérapeutiques classiques et s'associaient à une tendance d'issues neurodéveloppementale négatives.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it