October 30, 2008
Studies Warn About Intense Care For Premature Babies
Two studies published on Wednesday suggest that some of the intense care given to the smallest premature infants may be a little too intense.
Light treatment for jaundice may overwhelm the smallest infants, one study said, while another questions the practice of giving insulin to premature newborns.Babies weighing less than 2 pounds (1 kg) were slightly more likely to die if they were given early light therapy for rising levels of bilirubin, the compound that can turn the skin yellow but, more dangerously, can cause permanent brain damage, according to Dr. Brenda Morris of the University of Texas Medical School in Houston.
When the liver is slow to clear bilirubin, high-intensity light is used to break down the compound from outside the body.
The study of 1,974 infants found aggressively treating rising bilirubin levels reduces the rate of brain injury in the form of cerebral palsy, blindness, severe hearing loss and poor cognitive development, said the report, published in the New England Journal of Medicine.
Only 26 percent of light-treated babies had brain damage, compared 30 percent for babies whose treatment was delayed until the levels got a bit higher.
But researchers said that in the smallest babies, weighing 1.1 to 1.65 pounds (501 to 750 grams), those treated aggressively were 13 percent more likely to die than those who got conservative care.
Although the increase was not statistically significant"”meaning not enough babies died to know whether the pattern is more than a fluke"”Morris said doctors might want to pause before rushing into light therapy.
"Aggressive phototherapy may be preferred for infants with birth weights of 751 to 1000 grams (1.6 to 2.2 pounds), because we found significant neurodevelopmental benefits in this subgroup and no evidence that the therapy increased the rate of death or other outcomes at 18 to 22 months," they wrote.
"Jaundice is one of the many medical problems they're facing, so you need to look at these babies on an individual basis to decide what treatment would be best," said Higgins.
This marks the first study of light therapy since the 1970s, before advances allowed much smaller babies to survive.
A second team found that early insulin therapy offers little clinical benefit in very-low-birth-weight infants, putting them at risk of dangerous hypoglycemia or low blood sugar.
That team's trial of more than 300 babies showed that putting them on continuous insulin from birth raised the risk of death, with nearly 12 percent dying after four weeks, compared to 5.7 percent of infants not given insulin.
Dr. Kathryn Beardsall of Britain's University of Cambridge and colleagues wrote that mortality at 28 days was higher in the early-insulin group than in the control group.
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