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. 2008 Aug;153(2):234-40.
doi: 10.1016/j.jpeds.2008.01.028. Epub 2008 Mar 21.

Risk factors for severe hyperbilirubinemia among infants with borderline bilirubin levels: a nested case-control study

Michael W Kuzniewicz  1 , Gabriel J Escobar, Soora Wi, Petra Liljestrand, Charles McCulloch, Thomas B Newman
Affiliations

Risk factors for severe hyperbilirubinemia among infants with borderline bilirubin levels: a nested case-control study

Michael W Kuzniewicz et al. J Pediatr. 2008 Aug.

Abstract

Objective: To estimate the effect of phototherapy and other predictors on the risk of total serum bilirubin (TSB) >or= 25 mg/dL in infants with a TSB of 17 to 22.9 mg/dL at age >or= 48 hours.

Study design: From a cohort of 285295 infants >or= 34 weeks gestation and >or= 2000 g born between 1995 and 2004 in northern California Kaiser hospitals, we identified 17986 with a TSB of 17 to 22.9 mg/dL at age >or= 48 hours. All infants exhibiting a TSB >or= 25 mg/dL were selected as cases for the study. Four randomly selected controls were matched to each case based on the difference between their qualifying TSB and the American Academy of Pediatrics' phototherapy threshold.

Results: A total of 62 cases were identified (0.4%). Six of these (10%) received inpatient phototherapy within 8 hours, along with 101 controls (41%) (adjusted odds ratio [AOR] 0.15; 95% confidence interval [CI] 0.06 to 0.40). Cases more often had lower gestational age (AOR 3.24; 95% CI 1.24 to 8.47 for 38 to 39 weeks and AOR = 3.70; 95% CI 0.61 to 22.4 for 34 to 37 weeks compared with >or= 40-week infants), bruising, (AOR 2.52; 95% CI 1.16 to 5.50), exclusive breast-feeding (AOR 2.09; 95% CI 1.05 to 4.03), and TSB increase of >or= 6 mg/dL/day (AOR 2.39; 95% CI 1.18 to 4.85).

Conclusions: Phototherapy was 85% effective in preventing TSB >or= 25 mg/dL. The strongest predictors of TSB >or= 25 mg/dL were gestational age, bruising, family history, and rapid rise in TSB.

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Figures

Figure
Figure
Northern California KPMCP cohort and selection of cases and controls.
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