不同脐带处理策略对新生儿临床结局及检验指标的影响

目的:系统评价不同脐带处理策略对新生儿临床结局及检验指标的影响。方法:计算机检索国内外有关立即断脐(ICC)、延迟断脐(DCC)、脐带挤压(UCM)对新生儿结局影响的临床随机对照试验。严格质量评价后,采用R语言软件进行分析。结果:最终纳入22篇文献共4395例。结果表明,DCC与ICC相比可以提高早产儿出生后血细胞比容(MD 5.6,95%CI 1.97～9.24,P<0.01),可以提高足月儿出生后红细胞比容(MD 2.7,95%CI 0.55～4.86,P=0.01)和血清铁蛋白浓度(MD 17.16,95%CI 1.03～33.29,P=0.04),降低早产儿死亡率(RR 0.69,95%CI 0.49～0.97,P=0.03),脑室内出血(RR 0.57,95%CI 0.34～0.93,P=0.03)和败血症发生率(RR 0.46,95%CI 0.25～0.85,P=0.01),且不提高坏死性小肠炎(RR 0.52,95%CI 0.17～1.65,P>0.05)和早产儿视网膜病的发生率(RR 0.92,95%CI 0.37～2.25,P>0.05)。DCC与UCM相比,早产儿出生后慢性肺部疾病、死亡率、脑室内出血、坏死性小肠炎和败血症的发生率差异无统计学意义(P>0.05),对足月儿而言,DCC可以提高出生后血清铁蛋白浓度(MD 12.72,95%CI 10.47～14.98,P<0.01)。UCM与ICC相比,可以提高早产儿血红蛋白水平(MD 1.73,95%CI 0.62～2.84,P<0.01),早产儿出生后死亡率、脑室内出血、败血症、坏死性小肠炎和高钾血症的发生率差异无统计学意义(P>0.05)。结论:与ICC相比,DCC和UCM可能有益于改善新生儿的近期临床结局。     

妊娠期开展“孕妇学校”课程对新生儿结局影响的研究

目的:分析妊娠期开展“孕妇学校”课程对于新生儿结局的影响。方法:回顾性分析2018年10月—2019年8月在中国人民武装警察部队特色医学中心（我院）产科住院的单胎孕足月且妊娠期规律产检的孕妇资料,根据其妊娠期参加“孕妇学校”课程次数分为观察组高组（≥7次课程）、中组（4~6次课程）、低组（≤3次课程）及对照组（未参加课程）,各组分别有53例、56例、48例和69例孕妇纳入研究。观察各组新生儿结局指标,包括新生儿体质量、脐动脉血pH值、脐动脉血乳酸水平、出生后Apgar评分、胎粪吸入综合征（meconium aspiration syndrome,MAS）发生率、缺血缺氧性脑病（hypoxic ischemic encephalopathy,HIE）发生率、坏死性小肠炎（necrotizing enteritis,NEC）发生率及转入新生儿科率。结果:观察组高、中、低组在新生儿体质量、新生儿脐动脉血乳酸水平方面均低于对照组,差异均有统计学意义（P<0.05）;观察组高、中组在新生儿脐动脉血pH值、出生后1 min Apgar评分方面均高于对照组,差异有统计学意义（P<0.05）。观察组高、中、低组在新生儿出生后5 min Apgar评分、出生后10 min Apgar评分、新生儿发生MAS、HIE、NEC率及转入新生儿科率方面与对照组差异无统计学意义（P>0.05）。结论:妊娠期开展“孕妇学校”课程在一定程度上可以改善新生儿体质量、脐动脉血pH值、脐动脉乳酸水平及出生后1 min Apgar评分,值得孕期广泛开展。     

正常新生儿黄疸与围产因素的调查

目的 探讨围产期各种非病理因素对正常新生儿血清胆红素水平的影响。方法 对801例正常新生儿生后24h内开始监测血清胆红素水平,并记录围产期可能与新生儿黄疸有关的各种因素。被检测的新生儿按血清胆红素水平分为高胆红素组和随机对照组,比较两组间各种围产因素对生后5d内血清胆红素的影响。结果 母乳喂养、妊娠高血压综合征（简称妊高征）、出生体重下降和生后红细胞压积增高对正常新生儿早期血清胆红素水平有显著影响（P＜0．001）。母亲年龄、分娩方式、第二产时间、催产素使用时间、出生体重等两组比较差异无显著性。结论 母乳喂养,母亲妊高征、出生体重下降和生后红细胞压积增高,是正常新生儿出生后胆红素水平上升时期影响血清胆红素水平的重要潜在因素。     

妊娠中晚期双绒毛膜双胎一胎胎死宫内妊娠结局分析

目的：比较双绒毛膜双胎之一选择性减胎与自发一胎胎死宫内（single intrauterine fetal death,SIUFD）的围生期结局,并比较不同减胎孕周对围生期结局的影响,探讨选择性减胎的临床应用。方法：纳入2011年1月—2019年12月在南京大学医学院附属鼓楼医院产科终止妊娠的55例双胎之一胎死宫内或行选择性减胎术将双胎减至单胎的临床资料,根据减胎或死胎原因将其分为选择性减胎组（39例）和自发SIUFD组（16例）,回顾性分析比较其围生期结局。结果：55例患者总妊娠丢失率为9.1%（5例流产）,活产率为90.9%。选择性减胎组的减胎/死胎孕周明显低于自发SIUFD组,总体终止孕周、活产率明显高于自发SIUFD组,而剖宫产率、流产率则低于自发SIUFD组,差异均有统计学意义（P<0.05）。2组的早产率、足月产率、存活儿出生体质量、出生体质量百分位数、新生儿健康出院率、新生儿重症监护病房（neonatal intensive care unit,NICU）入住率比较,差异均无统计学意义（均P>0.05）。根据选择性减胎的孕周将选择性减胎组再分为减胎孕周≤20周组（24例）和减胎孕周>20周组（15例）,2组新生儿出生体质量百分位数比较差异无统计学意义（P>0.05）,但与减胎孕周>20周组比较,减胎孕周≤20周组的早产率低、足月产率高,存活儿出生体质量更高,差异有统计学意义（均P<0.05）。结论：双胎妊娠发生SIUFD后会对存活儿围生期结局产生不良影响,对于有减胎指征者,选择性减胎有利于提高存活儿围生期的活产率及改善新生儿结局,对多胎妊娠的围生期结局有益。     

中西医结合治疗足月新生儿黄疸146例疗效观察

目的观察中西医结合治疗新生儿黄疸的退黄效果与安全性。方法将432例足月新生儿黄疸患儿随机分为单纯光疗组140例、茵栀黄口服液＋光疗组146例、益生菌（酪酸梭状芽孢杆菌、婴儿型双歧杆菌）＋茵栀黄口服液＋光疗组146例。单纯光疗组：单面蓝光照射治疗每日16h;茵栀黄口服液＋光疗组：在单纯光疗组治疗基础上给予茵栀黄口服液每次5mL,每日2次;益生菌＋茵栀黄口服液＋光疗组：在茵栀黄口服液＋光疗组治疗基础上给予益生菌（酪酸梭菌二联活菌散）口服,每次1袋,每日2次,应用5～7d。定期测定血清胆红素,记录治疗过程中胆红素水平及副反应发生情况。结果单纯光疗组血清胆红素的下降慢于茵栀黄口服液＋光疗组、益生菌＋茵栀黄口服液＋光疗组,差异有统计学意义（P〈0.01）;茵栀黄口服液＋光疗组血清胆红素的下降慢于益生菌＋茵栀黄口服液＋光疗组,差异有统计学意义（P〈0.01）。益生菌＋茵栀黄口服液＋光疗组治疗过程中腹泻、红臀、体质量下降的发生明显减少,与单纯光疗组和茵栀黄口服液＋光疗组比较差异有统计学意义（P〈0.05）,其中茵栀黄口服液＋光疗组腹泻的发生率最高。结论茵栀黄口服液和益生菌均可加速蓝光治疗患儿的胆红素消退,两者联合可使光疗患儿血清胆红素较快下降,减少换血治疗的概率,并可减少副反应发生率。     

剖宫产新生儿断脐方法与血红蛋白关系探讨

目的探讨剖宫产新生儿的断脐方法以提高血红蛋白(Hb)水平,减少新生儿贫血的价值。方法 2009年7月至11月在北京大学人民医院剖宫产出生的足月新生儿,随机选择分为观察组(n=68)和对照组(n=54),两组新生儿均于娩出后即断脐,但观察组断脐时尽可能靠近胎盘,并于60s内将残留于新生儿端的脐带举起逆时针或顺时针转动,使脐静脉内的残余血完全流入新生儿体内;而对照组则行常规断脐。分别于新生儿出生后1h和24h各取1次静脉血查Hb和红细胞压积(HCT),第3天查血清总胆红素。结果观察组新生儿出生后1h、24h的Hb和HCT均高于对照组,两者之间差异有统计学意义,P值分别0.05和0.001。观察组新生儿无贫血病例,有1例高红细胞血症;而对照组有3例贫血,无高红细胞血症。两组新生儿第3天高胆红素血症的发生率和胆红素水平无明显差异,P0.05。结论剖宫产时靠近胎盘断脐并将残余脐静脉血输入新生儿体内,可提高新生儿的Hb,减少其贫血的发生,且不影响剖宫产儿的复苏和第三产程的管理。     

不同光疗方式对新生儿高胆红素血症疗效的观察

蓝光光疗因方法简便、疗效可靠，一直是新生儿高胆红素血症治疗的首选方法，但最近研究证实，蓝光照射时间过长可导致染色体损伤。本研究通过改变蓝光照射的方式，缩短了光疗时间，并与传统的持续光疗进行了疗效对照观察。一、对象和方法选择血清胆红素大于２０５．５μｍｏｌ／Ｌ并以间接胆红素增高为主的足月新生儿，男女不限，除外严重感染、肝脏疾病及遗传性疾病。按发病日龄、体重配对分为两组：间断光疗组：２８例，日龄（２．５±０．４）天，体重（３．２±０．６）ｋｇ；持续光疗组：２８例，日龄（２．９±０．７）天，体重（３．…     

早产儿配方奶粉对76例早产儿和（或）低出生体重儿实现早期追赶成长的疗效观察

目的 观察早产儿配方奶粉对早产儿（胎龄≤34周）和（或）低出生体重儿（体质量≤2.0 kg）实现早期追赶成长的效果.方法 151例早产儿和（或）低出生体重儿随机分为对照组75例和观察组76例.对照组给予普通奶粉喂养,观察组给予早产儿配方奶粉喂养,观察3个月末追赶成长和合并疾病情况.结果 观察组3个月末体质量、身长和头围追赶成长情况明显低于对照组,差异有统计学意义（P＜0.05）;观察组喂养期间贫血、感染和高胆红素血症发生率明显高于对照组,差异有统计学意义（P＜0.05）.结论 早产儿和（或）低出生体重儿早期使用早产儿配方奶粉,能够实现早期追赶成长,降低婴幼儿合并疾病的发生率,在促进脏器发育和系统完善具有非常重要的作用.     

葡萄糖6磷酸脱氢酶缺乏新生儿高胆红素血症发生率及其特点

目的研究葡萄糖 6 磷酸脱氢酶(G6PD)缺乏的新生儿高胆红素血症发生率及发病特点。方法对近5年来中山市陈星海医院产科分娩的足月健康新生儿脐带血进行G6PD定量测定，对G6PD活性缺乏的患儿，按性别和酶活性缺乏的程度分组调查其高胆红素血症的发生率及发病时间。结果(1)418例G6PD活性缺乏的患儿共发生高胆红素血症82例，占19.62%。(2)在G6PD活性缺乏的患儿中，男性酶的活性极显著低于女性(P<0.01)；高胆红素血症的发生率男性极显著高于女性(P<0.01)；酶活性缺乏程度不同的3组患儿高胆红素血症发生率有显著差别(P<0.05)；G6PD活性缺乏的患儿发生高胆红素血症的时间主要在出生后的1周内。结论在新生儿期，G6PD活性缺乏的患儿高胆红素血症的发生率较高，发病具有男性多于女性、酶活性缺乏程度越重高胆红素血症的发生率越高的特点，患儿发生高胆红素血症的高峰时间在出生后的2~4d。     

延迟钳夹脐带对剖宫产新生儿早期血液灌输的影响研究

目的　探讨延迟钳夹脐带对剖宫产新生儿早期血液灌输的影响。方法　2007年7月至2009年9月东莞石龙博爱医院产科经剖宫产分娩的137例新生儿随机分成两组,即常规钳夹脐带组（71例）和延迟钳夹脐带组（66例）。比较分析两组剖宫产新生儿的钳夹脐带时间、生后48 h血常规及生后3d内静脉血胆红素值和贫血的发生率。结果　两组剖宫产新生儿钳夹脐带时间、生后48 h内血常规指标及贫血发生率的比较差异有统计学意义（P < 0.05）,延迟钳夹脐带组贫血发生率减少。结论　延迟钳夹脐带对剖宫产新生儿早期血红蛋白（Hb）、红细胞压积（HCT）有显著影响,可减少剖宫产新生儿早期贫血的发生率。     

Placental transfusion: umbilical cord clamping and preterm infants.

OBJECTIVE: To investigate the clinical effects of early versus late cord clamping in preterm infants. STUDY DESIGN: A total of 32 premature infants were prospectively randomized. The following parameters were measured: Initial spun hematocrit (Hct), hemoglobin (Hgb), red blood cell (RBC) counts, frequency of blood transfusions, peak serum bilirubin, mean blood pressure (MBP), oxygen index, intraventricular hemorrhage, and significant patent ductus arteriosus (PDA). RESULTS: Over the 4-week study period, the delayed cord clamping (DCC) group exhibited a decrease in the frequency of blood transfusion (p < 0.001) and also a decrease in albumin transfusions over the first 24 hours (p < 0.03). MBP in the first 4 hours was higher in the DCC group (p < 0.01), and there were statistically significant increases in Hct (21%), Hgb (23%), and RBC count (21%) compared with the early cord clamping group. The risks of patent ductus arteriosus, hyperbilirubinemia, or intraventricular hemorrhage were similar in both groups. Late clamping of the umbilical cord had little or no effect on the oxygen index. CONCLUSION: DCC significantly reduced the requirement for blood and albumin transfusion. It also increased the initial Hct, RBC count, Hgb levels, and MBP.     

Early versus delayed cord clamping in term and preterm births: a review

The optimal timing for cord clamping, early versus delayed, in the third stage of labour is a controversial subject. Issues surrounding the timing of cord clamping include gestational age and maternal and neonatal considerations. Delayed cord clamping (DCC) has been shown to increase placental transfusion, leading to an increase in neonatal blood volume at birth of approximately 30%. In the term infant, although this may result in an increase in iron stores, thereby decreasing the risk of anemia, it may adversely increase the risk of jaundice and the need for phototherapy. In the preterm infant, DCC (or even milking of the cord) decreases the need for blood transfusions for anemia, the number of such transfusions, and the risks of intraventricular hemorrhage and late-onset sepsis. Advantages of DCC also include a reduction in alloimmunization in Rh-negative women, although this advantage is theoretical and unproven. We searched multiple databases including PubMed Clinical Queries, Trip Database, Cochrane Systematic Reviews, and UpToDate, as well as published guidelines from the Society of Obstetricians and Gynaecologists of Canada, the American Congress of Obstetricians and Gynecologists, and the Royal College of Obstetricians and Gynaecologists. We preferentially selected systematic reviews and randomized controlled trials for this literature review. Overall, the available evidence appears to suggest that DCC is likely to result in better neonatal outcomes in both term and preterm infants, even in areas where neonatal iron deficiency anemia is rare. However, there is insufficient evidence to date to support a recommendation to delay cord clamping in non-vigorous infants requiring resuscitation.     

延迟脐带结扎对新生儿及产妇的影响

足月儿和早产儿的适宜脐带结扎时间是多年来的争议话题。目前,各个国家、地区在临床实践中脐带结扎时间不一,主要分为2种：即刻脐带结扎指胎儿娩出后15 s内结扎脐带;延迟脐带结扎指胎儿娩出后至少30 s或等待脐带搏动停止后结扎脐带。延迟脐带结扎可增加胎盘内储血向新生儿体内的输血量,近期可提高新生儿血红蛋白水平,减少新生儿脑室内出血及晚期脓毒症的发生,且不增加产后出血发生率,远期可增加铁储备,降低贫血发生率。     

Alpha-thalassemia minor and neonatal hyperbilirubinemia

Infants on this island are known to have higher incidences of neonatal hyperbilirubinemia and alpha-thalassemia minor than Caucasians. In order to investigate the correlation between these two conditions, we collected a total of 110 newborns with alpha-thalassemia minor delivered at the National Taiwan University Hospital during the period from January 1985 through February 1988 for this retrospective study. The infants in the study group were ascertained to have the condition by the presence of Hb Bart's with a concentration from 3% to 13%, in the cord blood. None of them had glucose-6-phosphate dehydrogenase (G6PD) deficiency. For each study infant, two control infants were selected. Criteria for enrollment in the control group were: (1) same sex; (2) absence of G6PD deficiency; and (3) birth time as close as possible to that of the study infant, with the 1st control born before the study infant and the 2nd control after. The timing of bilirubin quantitation was based on clinical judgement of jaundice by the pediatricians and phototherapy was started as indicated. Gestational age, birth weight, and rates of preterm delivery, low birth weight infants and low Apgar scores were comparable between the study and control groups. On day 3 after birth, the incidence of hyperbilirubinemia (bilirubin level over 10 mg/dl) was significantly lower in the study group than in the control group (0.9% vs 9.5%, Fisher's exact probability = 0.0012). However, the difference was not significant later. The incidence of phototherapy was also significantly lower in the study group (20%) than in the control group (31%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Cochrane Update: Effect of timing of umbilical cord clamping at birth of term infants on mother and baby outcomes

BACKGROUND: Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord greater than one minute after the birth or when cord pulsation has ceased. OBJECTIVES: To determine the effects of different policies of timing of cord clamping at delivery of the placenta on maternal and neonatal outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Child Birth Group's Trials Register (December 2007). SELECTION CRITERIA: Randomized controlled trials comparing early and late cord clamping. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and quality and extracted data. MAIN RESULTS: We included 11 trials of 2,989 mothers and their babies. No significant differences between early and late cord clamping were seen for postpartum hemorrhage or severe postpartum hemorrhage in any of the five trials (2236 women) which measured this outcome (relative risk (RR) for postpartum hemorrhage 500 mls or more 1.22, 95% (CI) 0.96 to 1.55). For neonatal outcomes, our review showed both benefits and harms for late cord clamping. Following birth, there was a significant increase in infants needing phototherapy for jaundice (RR 0.59, 95% CI 0.38 to 0.92; five trials of 1,762 infants) in the late compared with early clamping group. This was accompanied by significant increases in newborn hemoglobin levels in the late cord clamping group compared with early cord clamping (weighted mean difference 2.17 g/dL; 95% CI 0.28 to 4.06; three trials of 671 infants), although this effect did not persist past six months. Infant ferritin levels remained higher in the late clamping group than the early clamping group at six months. AUTHORS' CONCLUSION: One definition of active management includes directions to administer an uterotonic with birth of the anterior shoulder of the baby and to clamp the umbilical cord within 30-60 seconds of birth of the baby (which is not always feasible in practice). In this review delaying clamping of the cord for at least two to three minutes seems not to increase the risk of postpartum hemorrhage. In addition, late cord clamping can be advantageous for the infant by improving iron status which may be of clinical value particularly in infants where access to good nutrition is poor, although delaying clamping increases the risk of jaundice requiring phototherapy.     

Cord clamping time in spontaneously breathing preterm neonates in the first minutes after birth: impact on cerebral oxygenation – a prospective observational study

Objective: To analyse impact of delayed cord clamping (DCC60sec) on cerebral regional tissue oxygenation (crSO2) and fractional tissue oxygen extraction (cFTOE) in spontaneously breathing preterm neonates during the first 15?min after birth.

Methods: Two-centre observational study, crSO2 and cFTOE was monitored in neonates with DCC60sec or early cord clamping (ECC?<?30?s).

Results: Seventy-six infants (birth weight and gestational age 1736?±?508?g and 31.8?±?2.5 weeks) were included. DCC was associated with lower initial crSO2 and higher cFTOE and lower initial Apgar-score and heart rate.

Conclusion: Attending practitioners should be aware that DCC might impact initial immediate transition in spontaneously breathing preterm neonates.     

Delayed cord clamping

Timing of cord clamping is believed to greatly affect placental transfusion rate and therefore neonatal and infant circulation. Delayed cord clamping of 30–60 seconds after birth, in combination with neonatal position at the level of placenta, respirations and uterine contractility increase haemoglobin and lower iron deficiency rate in both term and preterm infants. In preterm neonates, there is evidence on increased cardiovascular stability and a possible reduction of intraventricular haemorrhage and necrotising enterocolitis as well as need of blood transfusion. Adverse neonatal effects include increase of jaundice requiring phototherapy, without any adverse maternal effects reported, such as postpartum haemorrhage or anaemia. A possible adverse effect is the reduction of total nucleated cells during umbilical cord blood collection. Long term neurodevelopment has been assessed in term neonates, and a possible improvement of fine-motor and social domains in four years of life has been reported. Cord milking is an alternative technique to delayed cord clamping and as studies show, infant outcomes are at least comparable to delayed clamping. Delayed cord clamping of 30–60 seconds is therefore recommended, in both term and preterm neonates, provided there are no contra-indications and phototherapy facilities are available.     

Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial.

OBJECTIVE: This pilot study's aim was to establish feasibility of a protocol for delayed cord clamping (DCC) versus immediate cord clamping (ICC) at preterm birth and to examine its effects on initial blood pressure and other outcomes. STUDY DESIGN: A randomized controlled trial recruited 32 infants between 24 and 32 weeks. Immediately before delivery, mothers were randomized to ICC (cord clamped at 5 to 10 seconds) or DCC (30- to 45-second delay in cord clamping) groups. RESULTS: Intention-to-treat analyses revealed that the DCC group were more likely to have higher initial mean blood pressures (adjusted OR 3.4) and less likely to be discharged on oxygen (adjusted OR 8.6). DCC group infants had higher initial glucose levels (ICC=36 mg/dl, DCC=73.1 mg/dl; p=0.02). CONCLUSION: The research design is feasible. The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study.     

Which phototherapy system is most effective in lowering serum bilirubin in very preterm infants?

OBJECTIVE: To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels in preterm infants. METHODS: This randomized clinical trial enrolled 140 preterm infants with gestational age < or =30 weeks and presenting nonhemolytic hyperbilirubinemia. When total serum bilirubin level reached 6.0 mg/dl (102.6 micromol/l), eligible infants were randomly assigned to four study groups: conventional, fiberoptic Wallaby, fiberoptic Biliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion. RESULTS: Our results confirm that fiberoptic phototherapy, both Wallaby and Biliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions. CONCLUSION: Our data suggest that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants.     

Relationship between peri-intraventricular hemorrhage and neonatal hyperbilirubinemia in very low-birthweight infants

The incidence of hyperbilirubinemia (serum bilirubin values greater than 205 mumol/l) in two groups of preterm infants (birthweight less than 1500 gm) with and without peri-intraventricular hemorrhage (PIVH) was studied. In the first 10 days of life, 16 (39%) of the 41 infants with PIVH vs. 22 (46.8%) of those without PIVH (n = 47) had high bilirubin levels. No difference in peak serum bilirubin concentrations nor a need for phototherapy was noted between the two groups (P greater than 0.07). Forty-one infants had PIVH: 30 had PIVH grade I or II and 11 had grade III or IV. No statistically significant correlation was found between degree of PIVH and hyperbilirubinemia. Moreover, at 12 months corrected age, major and minor handicaps were equally distributed between the two groups. The neurologic outcome appeared to relate, in largest part, to the severity of the PIVH, and to not be influenced by the hyperbilirubinemia. We conclude that there is no positive relationship between incidence and extension of PIVH, plasma bilirubin levels, and outcome in very low-birth weight infants.