title: Is phototherapy exposure associated with better or worse outcomes in 501- to 1000-g-birth-weight infants?
abstract: OBJECTIVE
  To compare risk-adjusted outcomes at 18- to 22-month-corrected age for extremely low birth weight (ELBW) infants who never received phototherapy (NoPTx) to those who received any phototherapy (PTx) in the NICHD Neonatal Research Network randomized trial of Aggressive vs. Conservative Phototherapy.
  
  
  METHODS
  Outcomes at 18 to 22-month-corrected age included death, neurodevelopmental impairment (NDI) and Bayley Scales Mental Developmental Index (MDI). Regression models evaluated the independent association of PTx with adverse outcomes controlling for centre and other potentially confounding variables.
  
  
  RESULTS
  Of 1972 infants, 216 were NoPTx and 1756 were PTx. For the entire 501- to 1000-g-BW cohort, PTx was not independently associated with death or NDI (OR 0.85, 95% CI: 0.60-1.20), death or adverse neurodevelopmental endpoints. However, among infants 501-750 g BW, the rate of significant developmental impairment with MDI < 50 was significantly higher for NoPTx (29%) than PTx (12%) (p = 0.004).
  
  
  CONCLUSIONS
  Phototherapy did not appear to be independently associated with death or NDI for the overall ELBW group. Whether PTx increases mortality could not be excluded because of bias from deaths before reaching conservative treatment threshold. The higher rate of MDI < 50 in the 501- to 750-g-BW NoPTx group is concerning and consistent with NRN Trial results.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. srhintz@stanford.edu
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: Qing
authors.initials: Q
authors.lastname: Yao
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Brenda H
authors.initials: BH
authors.lastname: Morris
authors.forename: Jon E
authors.initials: JE
authors.lastname: Tyson
authors.forename: William
authors.initials: W
authors.lastname: Oh
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Poole
authors.forename: Dale L
authors.initials: DL
authors.lastname: Phelps
authors.forename: Georgia E
authors.initials: GE
authors.lastname: McDavid
authors.forename: Cathy
authors.initials: C
authors.lastname: Grisby
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D010789:Phototherapy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011597:Psychomotor Performance; D020379:Risk Adjustment; D016896:Treatment Outcome