Rethinking the Assessment of Hyperbilirubinemia in Preterm Infants
Bibliographic record
Abstract
Preterm infants born at 240/7 to 356/7 weeks’ gestation are at greater risk of developing acute bilirubin encephalopathy (ABE) and chronic bilirubin encephalopathy (CBE). However, guidelines for the assessment of hyperbilirubinemia are consensus-based, and systematically derived pre-treatment total serum bilirubin (TSB) percentiles are lacking for preterm infants. Preterm infants who undergo repeat TSB testing are subjected to greater stress, pain, and risk of anemia. To address the aforementioned issues, two multi-site retrospective (Study 1 and 2), and one multi-site prospective (Study 3), cohort studies were conducted at three neonatal intensive care units (NICUs) in Ontario. Study 1 generated pre-treatment TSB percentile levels among infants born at 290/7 to 356/7 weeks’ gestation, using quantile regression. Study 2 generated pre-phototherapy TSB percentiles levels at 24 hours of age among infants born at 240/7 to 286/7 weeks’ gestation and contrasted those pre-phototherapy TSB percentiles with existing consensus-based thresholds produced by Maisels. Study 3 investigated the agreement between transcutaneous bilirubin (TcB) and TSB measurements among preterm infants born at 240/7 to 356/7 weeks, overall, by receipt of phototherapy, by anatomical site of measurement and by self-reported maternal ethnicity. Study 1 produced hour-specific pre-treatment TSB levels at the 40th, 75th and 95th percentiles, with corresponding curves by gestational week at birth. Study 2 observed considerably higher statistically derived pre-phototherapy TSB percentile levels at 24 hours of age at the 75th and 95th percentile than Maisels’ consensus-based TSB thresholds. Study 3 observed higher agreement between TcB and TSB values among preterm infants born at 330/7 to 356/7 weeks’ gestation, prior to phototherapy, whether measured at the forehead or sternum. TcB-TSB agreement was not impacted by ethnicity. The results of this thesis provide new information about bilirubin measurement in preterm infants. Experts and health policy makers may choose to use these data to inform evidence-based guidelines in the assessment (and management) of hyperbilirubinemia in preterm infants.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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 source (direct Gemma or distilled Codex), 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".