2 Neuro-Developmental Outcomes at 18 Months Corrected Age in Infants Weighing <1500 Grams Enrolled in a Randomized Trial of Agressive Versus Conservative Phototherapy
Bibliographic record
Abstract
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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How this classification was reachedexpand
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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".