Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. 1352-1359 (doi:10.1542/peds.2008-1635)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Newman, T. B.
Right arrow Articles by Escobar, G. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Newman, T. B.
Right arrow Articles by Escobar, G. J.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Numbers Needed to Treat With Phototherapy According to American Academy of Pediatrics Guidelines

Thomas B. Newman, MD, MPHa,b,c, Michael W. Kuzniewicz, MD, MPHc,d, Petra Liljestrand, PhDa,c, Soora Wi, MPHc, Charles McCulloch, PhDa and Gabriel J. Escobar, MDc,e

a Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics
Divisions of; b General Pediatrics
d Neonatology, Department of Pediatrics, University of California, San Francisco, California
c Division of Research, Kaiser Permanente Medical Care Program, Oakland, California
e Department of Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California

OBJECTIVES. Our aims were to estimate the efficacy of hospital phototherapy for neonatal jaundice and the number needed to treat to prevent one infant from reaching the exchange transfusion level.

METHODS. From a cohort of 281 898 infants weighing ≥2000 g born at ≥35 weeks' gestation at 12 Northern California Kaiser hospitals from 1995 to 2004, we identified 22 547 who had a "qualifying total serum bilirubin level" within 3 mg/dL of the American Academy of Pediatrics 2004 guideline phototherapy threshold. We used multiple logistic regression to estimate the efficacy of hospital phototherapy within 8 hours at preventing the bilirubin level from exceeding the 2004 guideline's exchange transfusion threshold within 48 hours. We combined this efficacy estimate with other predictors of risk to estimate the numbers needed to treat at different values of covariates.

RESULTS. Of the 22 547 eligible newborns, 5251 (23%) received hospital phototherapy within 8 hours of their qualifying bilirubin level. Only 354 (1.6%) ever exceeded the guideline exchange transfusion threshold; 187 (0.8%) did so within 48 hours. Among infants who did not have a positive direct antiglobulin test, hospital phototherapy within 8 hours was highly effective (adjusted odds ratio, 0.16; 95% confidence interval, 0.07–0.34). For infants with bilirubin levels 0–0.9 mg/dL above the phototherapy threshold, the estimated number needed to treat at mean values of covariates was 222 (95% CI: 107–502) for boys and 339 (95% CI: 154–729) for girls, ranging from 10 (95% CI: 6–19) for <24-hour-old, 36-week gestation boys to 3,041 (95% CI: 888–11 096) for ≥3-day-old 41-week girls. Hospital phototherapy was less effective for infants direct antiglobulin test-positive infants (adjusted odds ratio 0.55; 95% CI: 0.21–1.45; P = 0.01 for the direct antiglobulin test x phototherapy interaction).

CONCLUSIONS. While hospital phototherapy is effective, the number needed to treat according to current guidelines varies considerably across different infant subgroups.

Key Words: hyperbilirubinemia • jaundice • phototherapy • exchange transfusion • clinical guidelines • cohort studies • kernicterus • risk assessment

Abbreviations: AAP—American Academy of Pediatrics • NNT—number needed to treat • TSB—total serum bilirubin • NC-KPMCP—Northern California Kaiser Permanente Medical Care Program • DAT—direct antiglobulin test • OR—odds ratio • CI—confidence interval

Accepted Sep 11, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
M. W. Kuzniewicz, G. J. Escobar, and T. B. Newman
Impact of Universal Bilirubin Screening on Severe Hyperbilirubinemia and Phototherapy Use
Pediatrics, October 1, 2009; 124(4): 1031 - 1039.
[Abstract] [Full Text] [PDF]