Original articleRisk Factors for Severe Hyperbilirubinemia among Infants with Borderline Bilirubin Levels: A Nested Case-Control Study
Section snippets
Study Design
This nested case-control study began with a cohort of 285 295 infants born in northern California Kaiser Permanente Medical Care Program (KPMCP) hospitals between January 1, 1995 and December 30, 2004, who were at least 34 weeks gestational age and weighed ≥ 2000 g at birth. The KPMCP has information systems built around a common medical record number, permitting linkage across multiple laboratory and neonatal databases.2, 15, 16, 17
Subjects
The Figure illustrates the sample selection. We identified 17
Results
There were 17,986 infants with a TSB between 17 and 22.9 mg/dL at age ≥ 48 hours. Of this group, 62 infants reached a TSB ≥ 25 mg/dL. For 1859 infants, their last TSB was also their highest TSB measured, suggesting incomplete follow-up. The maximum TSB levels of these 1859 infants were drawn at a mean age of 4.5 days, and 92% were < 20 mg/dL.
Table I summarizes characteristics of the study cohort. The cases and controls did not differ significantly by sex, race, birth weight, or duration of
Discussion
Our study illustrates what factors physicians should take into account when making difficult treatment decisions in infants with TSB between 17 and 22.9 mg/dL at 48 hours or longer after birth. At study entry, 97% of the infants had a TSB level above the 2004 AAP threshold for phototherapy; however, only 35% of all infants received inpatient phototherapy. This underscores the substantial variation in treating these infants and the need for an evidence-based approach to treating neonatal
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Cited by (0)
Supported by by National Institute of Child Health and Human Development grant RO1 HD047557 and a grant from the Glaser Pediatric Research Network (M.K.)
No reprints are available from the authors.