Is phototherapy exposure associated with better or worse outcomes in 501- to 1000-g-birth-weight infants?

Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Acta Paediatrica (Impact Factor: 1.67). 07/2011; 100(7):960-5. DOI: 10.1111/j.1651-2227.2011.02175.x
Source: PubMed


 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.
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.
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).
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.

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    • "Additionally, phototherapy has been shown to have limited effect in modulating elevated TB levels due to Coombs-positive hemolytic disease and cannot be considered as a substitute for exchange transfusion (Maurer et al., 1985). It is also conceivable that hyperbilirubinemia treatment with Mps could be beneficial for premature infants, which have very thin skin, thus light can penetrate deeper into tissue and cause photooxidative injury (Vreman et al., 2004; Hintz et al., 2011). This effect might be reduced with Mps treatment, if they are used alone and not in combination with phototherapy. "
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