title: The bilirubin albumin ratio in the management of hyperbilirubinemia in preterm infants to improve neurodevelopmental outcome: a randomized controlled trial--BARTrial.
abstract: OBJECTIVE
  High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome.
  
  
  METHODS
  In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death.
  
  
  RESULTS
  Composite motor (100 ± 13 vs. 101 ± 12) and cognitive (101 ± 12 vs. 101 ± 11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤ 1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g.
  
  
  CONCLUSIONS
  The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN74465643.
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Christian V
authors.initials: CV
authors.lastname: Hulzebos
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Dijk
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Deirdre E
authors.initials: DE
authors.lastname: van Imhoff
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
authors.affiliation: Department of Orthopedagogy, University of Groningen, Groningen, The Netherlands.
authors.forename: Selma A J
authors.initials: SA
authors.lastname: Ruiter
authors.affiliation: Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Koen N J A
authors.initials: KN
authors.lastname: van Braeckel
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Paul F M
authors.initials: PF
authors.lastname: Krabbe
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Elise H
authors.initials: EH
authors.lastname: Quik
authors.affiliation: Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Letty
authors.initials: L
authors.lastname: van Toledo-Eppinga
authors.affiliation: Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Debbie H G M
authors.initials: DH
authors.lastname: Nuytemans
authors.affiliation: Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Aleid G
authors.initials: AG
authors.lastname: van Wassenaer-Leemhuis
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Manon J N
authors.initials: MJ
authors.lastname: Benders
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karen K M
authors.initials: KK
authors.lastname: Korbeeck-van Hof
authors.affiliation: Princess Amalia Department of Pediatrics, Department of Neonatology, Isala, Zwolle, The Netherlands.
authors.forename: Richard A
authors.initials: RA
authors.lastname: van Lingen
authors.affiliation: Princess Amalia Department of Pediatrics, Department of Neonatology, Isala, Zwolle, The Netherlands.
authors.forename: Liesbeth J M
authors.initials: LJ
authors.lastname: Groot Jebbink
authors.affiliation: Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands.
authors.forename: Djien
authors.initials: D
authors.lastname: Liem
authors.affiliation: Division of Neonatology, Department of Pediatrics, UMC St. Radboud Nijmegen, Nijmegen, The Netherlands.
authors.forename: Petri
authors.initials: P
authors.lastname: Mansvelt
authors.affiliation: Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Buijs
authors.affiliation: Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Govaert
authors.affiliation: Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Ineke
authors.initials: I
authors.lastname: van Vliet
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: Twan L M
authors.initials: TL
authors.lastname: Mulder
authors.affiliation: Department of Pediatrics, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: Cecile
authors.initials: C
authors.lastname: Wolfs
authors.affiliation: Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Willem P F
authors.initials: WP
authors.lastname: Fetter
authors.affiliation: Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Celeste
authors.initials: C
authors.lastname: Laarman
mesh_terms: D001663:Bilirubin / Q000032:analysis*; D001724:Birth Weight; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood* / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007647:Kernicterus / Q000517:prevention & control*; D008297:Male; D010789:Phototherapy; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin; D001663:Bilirubin