Pre-phototherapy total serum bilirubin levels in extremely preterm infants

Thivia Jegathesan^{1

2}, Joel G Ray^{1

3

4}, Charles Donald George Keown-Stoneman^{5

6}, Douglas M Campbell^{1

2

7}, Vibhuti Shah^{4

7

8}, Howard Berger^{3

4}, Robin Z Hayeems^{4

9}, Michael Sgro^{10

11

12}; NeoHBC

Collaborators, Affiliations

Affiliations

¹ Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Pediatrics and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
³ Department of Obstetrics and Gynecology and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Applied Health Research Centre, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁶ Dalla Lana School of Public Health, Biostatistics Division, University of Toronto, Toronto, ON, Canada.
⁷ Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.
⁸ Department of Paediatrics, Sinai Health, Toronto, ON, Canada.
⁹ Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.
¹⁰ Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.
¹¹ Department of Pediatrics and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.
¹² Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.

PMID: 35523883
DOI: 10.1038/s41390-022-02065-0

Pre-phototherapy total serum bilirubin levels in extremely preterm infants

Thivia Jegathesan et al. Pediatr Res. 2023 Jan.

. 2023 Jan;93(1):226-232.

doi: 10.1038/s41390-022-02065-0. Epub 2022 May 6.

Authors

Affiliations

¹ Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Pediatrics and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
³ Department of Obstetrics and Gynecology and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ Applied Health Research Centre, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
⁶ Dalla Lana School of Public Health, Biostatistics Division, University of Toronto, Toronto, ON, Canada.
⁷ Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.
⁸ Department of Paediatrics, Sinai Health, Toronto, ON, Canada.
⁹ Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.
¹⁰ Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.
¹¹ Department of Pediatrics and Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.
¹² Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada. Michael.Sgro@unityhealth.to.

PMID: 35523883
DOI: 10.1038/s41390-022-02065-0

Abstract

Background: Extremely preterm infants are prone to hyperbilirubinemia and its sequelae. Currently recommended thresholds for initiating phototherapy in these newborns are consensus-based (CB).

Methods: A multi-site retrospective cohort study of 642 infants born at 24^0/7 to 28^6/7 weeks' gestation, between January 2013 and June 2017, was conducted at three NICUs in Canada. Pre-phototherapy TSB percentile levels at 24 h of age were generated and contrasted with published CB thresholds.

Results: Among infants born 24^0/7 to 25^6/7 weeks' gestation, the differences between our TSB percentiles vs. the CB threshold of 85.0 µmol/L were 10.0 µmol/L (95% CI, 6.0-16.0) at the 75th percentile and 35.3 µmol/L (95% CI, 26.1-42.8) at the 95th percentile. Respectively, among infants born at 26^0/7 to 27^6/7 weeks, differences were 19.4 µmol/L (95% CI, 16.8-23.4) and 43.3 µmol/L (95% CI, 34.7-46.9). Born at 28^0/7 to 28^6/7 weeks' gestation, differences between our 75th and 95th TSB percentiles and the CB threshold of 103 µmol/L were 6.9 µmol/L (95% CI, 3.2-12.0) and 36.0 µmol/L (95% CI, 31.0-44.3), respectively.

Conclusions: We provide statistically derived pre-phototherapy TSB levels that may clarify patterns of pre-phototherapy TSB levels in extremely preterm infants.

Impact: We present statistically derived pre-phototherapy total serum bilirubin levels in a cohort of extremely preterm infants. Most of these preterm infants received phototherapy-some at below currently published thresholds. There are notable differences between our statistically derived pre-phototherapy TSB levels and currently published lower limit TSB thresholds for phototherapy. Our study results assist in the understanding of pre-phototherapy TSB levels in extremely preterm infants.

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References

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1. Olds, C. & Oghalai, J. S. Bilirubin-induced audiologic injury in preterm infants. Clin. Perinatol. 43, 313–323 (2016). - DOI
1. Bhutani, V. K. & Wong, R. J. Bilirubin neurotoxicity in preterm infants: risk and prevention. J. Clin. Neonatol. 2, 61–69 (2013). - DOI
1. Hulzebos, C. V., van Dommelen, P., Verkerk, P. H., Dijk, P. H. & Van Straaten, H. L. Evaluation of treatment thresholds for unconjugated hyperbilirubinemia in preterm infants: effects on serum bilirubin and on hearing loss? PLoS ONE 8, e62858 (2013). - DOI

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Pre-phototherapy total serum bilirubin levels in extremely preterm infants

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Pre-phototherapy total serum bilirubin levels in extremely preterm infants

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