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Published on: November 20, 2015
Hyperbilirubinemia Among Infants Born Preterm: Peak Levels and Association with Neurodevelopmental Outcomes
Gonzalo Solis-Garcia1, Kamini Raghuram2, Sajit Augustine3
1Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Integrated Neonatal Perinatal Fellowship Program, University of Toronto, Toronto, Ontario, Canada.
High peak bilirubin levels in premature infants born before 29 weeks gestation are linked to neurodevelopmental and hearing impairments. This association was observed in the highest quartile of peak bilirubin, highlighting potential risks for extremely preterm infants.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Hyperbilirubinemia is a common condition in newborns, particularly those born preterm.
- Understanding the distribution and impact of peak bilirubin levels is crucial for managing extremely preterm infants.
- Neurodevelopmental outcomes in this vulnerable population are often affected by various neonatal morbidities.
Purpose of the Study:
- To determine the distribution of peak bilirubin levels in infants born before 29 weeks gestation within the first 14 days of life.
- To investigate the association between quartiles of peak bilirubin levels and neurodevelopmental outcomes at different gestational ages.
Main Methods:
- A multicenter, retrospective, nationwide cohort study was conducted using data from the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network.
- Included were neonates born between 22 0/7 and 28 6/7 weeks of gestation between 2010 and 2018.
- Peak bilirubin levels were recorded in the first 14 days; neurodevelopmental impairment was defined by cerebral palsy, cognitive/motor delays, visual, or hearing impairment.
Main Results:
- A total of 12,554 newborns were included, with a median gestational age of 26 weeks.
- Median peak bilirubin levels increased with gestational age, from 112 mmol/L at 22 weeks to 156 mmol/L at 28 weeks.
- The highest quartile of peak bilirubin was associated with increased odds of significant neurodevelopmental impairment (aOR 1.27) and hearing impairment requiring a hearing aid (aOR 3.97).
Conclusions:
- Peak bilirubin levels in neonates born before 29 weeks gestation increase with advancing gestational age.
- Elevated peak bilirubin levels in the highest quartile are significantly associated with neurodevelopmental and hearing impairments.
- These findings underscore the importance of monitoring and managing hyperbilirubinemia in extremely preterm infants to mitigate long-term adverse outcomes.
