Does aggressive phototherapy increase mortality while decreasing profound impairment among the smallest and sickest newborns?

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Date: Sept. 2012
From: Journal of Perinatology(Vol. 32, Issue 9)
Publisher: Nature Publishing Group
Document Type: Report
Length: 5,913 words
Lexile Measure: 1630L

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Abstract :

Objective: Aggressive phototherapy (AgPT) is widely used and assumed to be safe and effective for even the most immature infants. We assessed whether the benefits and hazards for the smallest and sickest infants differed from those for other extremely low-birth-weight (ELBW; [less than or equal to] 1000 g) infants in our Neonatal Research Network trial, the only large trial of AgPT. Study Design: ELBW infants (n = 1974) were randomized to AgPT or conservative phototherapy at age 12 to 36 h. The effect of AgPT on outcomes (death, impairment, profound impairment, death or impairment (primary outcome), and death or profound impairment) at 18 to 22 months of corrected age was related to BW stratum (501 to 750 g; 751 to 1000 g) and baseline severity of illness using multilevel regression equations. The probability of benefit and of harm was directly assessed with Bayesian analyses. Result: Baseline illness severity was well characterized using mechanical ventilation and Fi[O.sub.2] at 24 h age. Among mechanically ventilated infants [less than or equal to] 750 g BW (n = 684), a reduction in impairment and in profound impairment was offset by higher mortality (P for interaction Conclusion: Findings from the only large trial of AgPT suggest that AgPT may increase mortality while reducing impairment and profound impairment among the smallest and sickest infants. New approaches to reduce their serum bilirubin need development and rigorous testing. Journal of Perinatology (2012) 32, 677-684; doi: 10.1038/jp.2012.64; published online 31 May 2012 Keywords: phototherapy; bilirubin; ELBW infant; randomized clinical trial; statistical interaction; Bayesian analysis

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Gale Document Number: GALE|A302298856