Objective
To evaluate if jaundice, indexed by unbound bilirubin (UB), is associated with central apnea in premature infants.
Study design
A prospective observational study was performed with 27–33 weeks gestational age infants who were not requiring either mechanical ventilation or non-invasive ventilation with continuous positive airway pressure beyond 24 hours after birth. Infants with congenital infections, chromosomal disorders, cranio-facial anomalies, and/or family history of hearing loss were excluded. Total serum bilirubin and UB were measured twice daily during the first postnatal week and then when clinically indicated. Central apnea was evaluated by visual inspection of continuous electronic cardio-respiratory recordings until two weeks of age.
Results
100 infants were sub-divided into two groups using the median peak UB level: High UB group (> median) and Low UB group (< median). The High UB group had an increased frequency of apnea events during the first two weeks compared to infants with the Low UB group. After controlling for confounders, the High UB group had more apnea events during the first two postnatal weeks compared to the Low UB group (Incidence Rate Ratio: 1.9, 95% CI: 1.2–3.2).
Conclusions
Our findings suggest that jaundice, as indexed by UB, is associated with central apnea in premature infants.