极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

Improved outcome in very low birth weight infants from 1977 to 1983

Changes of mortality and neurological morbidity in 351 very low birth-weight infants cared for in the neonatal intensive care unit of the Children's Hospital Tübingen during the years 1977 to 1983 are reported. The main finding was a survival rate increasing from 69.5% in 1977–79 to 76.6% in 1982–83 and a coinciding frequency of severe neurological sequelae decreasing from 9.2%–3.7%. The incidence of minor neurodevelopmental problems remained unchanged. However, mortality after discharge was found to be increased during the period observed. In conclusion, the intensification of neonatal intensive care in our hospital did not only reduce mortality but also the rate of severe neurological sequelae, thus not only survival rate but also the quality of survival could be improved.Abbreviations VLBW very low birth weight - LBW low birth weight - NICU neonatal intensive care unit - BPD bronchopulmonary dysplasia     

超低和极低出生体重儿神经发育结局及影响因素分析

目的 评估超低/极低出生体重儿 （ELBWI和VLBWI） 在纠正年龄 （CA） 18月时神经发育结局,探讨影响神经发育结局的因素。方法 收集2013年1月至2014年6月入住新生儿重症监护病房并存活出院的ELBWI和VLBWI病例,在CA40周、1、3、6、12、18月定期随访,评估神经发育结局。按神经发育状况分为神经发育正常组和神经发育异常组,比较两组临床资料的差异,分析ELBWI和VLBWI神经发育的危险因素。结果 共338例ELBWI和VLBWI纳入研究,15例在住院期间死亡。CA18月时,145例 （44.9%） 存活且随访资料完整,75例 （23.2%） 死亡,失访103例 （31.9%）。CA18月时,145例患儿中神经发育损伤71例 （49.0%）,3例 （2.1%） 脑性瘫痪;未发现单眼或双眼失明的视觉损伤及需要助听器的听觉损伤。Logistic回归分析发现BPD和败血症是ELBWI和VLBWI神经发育异常的独立危险因素 （OR=3.530,P < 0.001;OR=2.528,P=0.035）,BPD发生程度越重,神经发育异常的发生率越高。结论 败血症、BPD （尤其是重度BPD） 是ELBWI和VLBWI神经发育异常的危险因素。     

极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。     

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND: Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported. AIMS: To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition. METHODS: A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted. RESULTS: Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks. CONCLUSIONS: These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.     

极低及超低出生体重儿肺出血的影响因素及预后分析

目的 探讨极低及超低出生体重(出生体重≤1200g)早产儿肺出血的影响因素及预后.方法 回顾性分析2010年1月至2015年12月于中国医科大学附属盛京医院第二新生儿科住院、出生体重≤1200g、住院期间发生肺出血的极低及超低出生体重儿临床资料,同期住院、相同体重范围非肺出血早产儿作为对照组.比较两组母孕期及新生儿期特点,多元回归分析探讨肺出血影响因素,了解肺出血新生儿的近期预后.结果 肺出血新生儿(肺出血组)71例,对照组364例.肺出血发生于 3d 以内者57例(占80.3%),肺出血组胎龄(28.2±1.7)周、出生体重(936±192)g,均明显低于对照组[(29.5±2.1)周,(1033±134)g,t分别为4.776、-5.145,P<0.01].肺出血组呼吸窘迫综合征(RDS)(76.1%)、肺表面活性物质治疗(76.1%,其中≥2次使用率9.9%)、动脉导管未闭(PDA)(66.2%)比例均明显高于对照组[41.2%、30.8%(4.1%)和38.7%,χ2值分别为33.457、28.970(4.074)和32.798,P<0.05].肺出血组产前类固醇激素治疗率(21.1%)亦明显低于对照组(41.2%,χ2=10.177,P<0.01).多因素Logistic逐步回归分析显示,RDS(OR=3.739,95%CI 1.383-10.113,P<0.05)、PDA(OR=2.206,95%CI 1.205-4.093,P<0.05)及5 min Apgar评分<7(OR=2.851,95%CI 1.191-6.828)是肺出血的独立危险因素;出生体重大(OR=0.998,95%CI 0.996-1.000,P<0.05)及母孕期应用激素 (OR=0.432,95%CI 0.224-0.834,P<0.05)是肺出血的保护因素.肺出血组颅内出血、早产儿视网膜病及重度支气管肺发育不良发生率(16.9%、12.7%及18.3%)明显高于对照组(5.8%、4.4%及2.2%,χ2值分别为36.824、7.520及33.568,P<0.01).肺出血组病死率(49.3%)亦明显高于对照组(14.0%,χ2=46.634,P<0.01).结论 多种围生期因素与肺出血有关;预防早产及产前类固醇激素治疗有助于预防肺出血;肺出血新生儿不良预后发生率高.     

极低出生体重儿颅内出血危险因素的分析

目的：颅内出血是造成极低出生体重（VLBW）儿智力及运动障碍主要原因之一,了解其发病的危险因素、及早预防,可减少残疾、提高生存质量。方法研究169例极低出生体重儿,对产前因素及生后因素进行分析,采用SPSS12.0对数据进行卡方检验,有意义因素再进行logistic回归分析,得出回归方程。结果胎膜早破、1分钟Apgar评分≤7分、使用PS及呼吸机治疗、上机时间＞3 d、入院时PT＞20 s、生后1 d和2 d低钠血症及生后1 d pH值＜7.25为VLBW颅内出血危险因素。结论1分钟Apgar评分≤7分和使用呼吸机治疗是VLBW儿颅内出血的主要危险因素,而凝血功能和内环境紊乱均与缺氧窒息有关。因此,作好产前保健,减少窒息及生后合并症发生,有利于降低VLBW儿颅内出血发生率,提高患儿生存质量。 ［中国当代儿科杂志,2007,9（4）：297-300］     

极低出生体重儿血清铁蛋白水平及影响因素

目的 分析极低出生体重儿(very low birth weight infants,VLBWI)的铁营养状况及影响其变化的因素.方法 收集2014年1月至12月我院收治的115例VLBWI,检测其基础血清铁蛋白及出院前末次血清铁蛋白水平,并对可能的影响因素如胎龄、出生体重、基础血红蛋白、住院期间累积输血量、累积失血量,孕母糖尿病、高血压及贫血等临床资料进行分析.结果 115例VLBWI的基础血清铁蛋白为100.8 ～210.3 μg/L,平均(140.32±13.21) μg/L;不同胎龄的VLBWI基础血清铁蛋白水平比较差异有统计学意义(F=14.367,P=0.000),胎龄＜32周的LBWI其基础血清铁蛋白最低[(124.5±31.3) g/L].母亲贫血程度越重,婴儿基础血清铁蛋白越低[无贫血:(230.9±68.7) μg/L,轻度贫血:(189.5 ±75.3) μtg/L,中度贫血:(133.5 ±88.1) μg/L,重度贫血:(122.2 ±56.8) μg/L;P ＜0.05].VLBWI基础血红蛋白水平越低,其基础血清铁蛋白水平越低(P＜0.05).同时VLBWI住院期间末次血清铁蛋白水平受累积输血量的影响差异有统计学意义(P＜0.05).结论 提高VLBWI基础血红蛋白水平对增加VLBWI体内铁储备是有益的,定期监测住院期间甚至出院后血清铁蛋白以指导VLBWI补铁治疗十分必要.     

Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight北大核心CSCD

Objective To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW). Methods A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis. Results Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05). Conclusions VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC. © 2023 Xiangya Hospital of CSU. All rights reserved.     

Prenatal and postnatal factors affecting short-term survival of very low birth weight infants

Factors affecting the survival of 175 preterm infants born with body weight <1500 g were examined. The still-birth and perinatal mortality rates were 143 and 446 per 1000 births respectively; neonatal death rate was 447 per 1000 live births. Survival improved progressively with increasing gestational age, and survival was better for infants born after 27 weeks of gestation. Neither maternal nor labour and delivery variables significantly affected survival. Male infants had half the survival rate of females. Birth asphyxia, hypercapnia and respiratory distress syndrome were the most common forms of morbidity, occurring in >20% of the population. Infants with such pathology had significantly lower survival rates.Abbreviations VLBW very low birth weight - NICU neonatal intensive care units - PROM premature rupture of the membranes - RDS respiratory distress syndrome - RR relative risk - SGA small for gestational age - AGA adequate for gestational age - ELBW extremely low birth weight The Italian Collaborative Study on Preterm Delivery was carried out by the following investigators: Maurizio Bonati, Carlo Brambilla, Fabio Colombo and Gianni Tognoni, Milan (Co-ordinating Centre); Cristina Begher, Salvatore Bottino, Umberto Faluto and Mario Maccabruni, Monza (MI); Bruno Granati and Paola Zanor, Padova, Pierangelo Burtuletti, Gabriella Manenti and Giuliana Pasinetti, Bergamo; Carlo Corchia, Sassari; Enrico Bertino, Aldo Capra, Wanda Combetto, Maria Pia Corradin, Claudio Fabris and Claudio Martano, Torino; Michele Angiolillo and Luigi Gaioni, Mantova; Rosanna Casellato and Giorgio Suppi, Treviso; Augusto Montaguti, Cesena; Susanna Martignoni and Antonio Tomassini, Varese; Paolo Bianchi and Giuliano Palmerio, Seriate (BG); Fulvia Cellani, Francesco Grossi and Vincenzo Rossi, Lodi (MI); Antonia Carlino, Crena (CR); Alessandra Favero, Stefano Quaranta and Raffaella Tornaghi, Milan; Giuseppe Assenza, Fiesole (FI); Massimo Bardi, Arturo Manzoni, Daria Mattioni and Ferruccio Pizzigoni, Trescore (BG); Mario Berzioli and Vittorio Marsoni, Montebelluna (TV); Giovanni Buzzi and Angela Tudisco, Casale Monferrato (AL); Gabriele Oppo, Arezzo; Domenico Fichera, Calcinate (BG); Giuseppe Marraro and Alberto Vecchione, Merate (CO)     

极低出生体重儿肠道喂养延迟的近期临床结局和围生期危险因素分析

目的 探讨极低出生体重儿(very low birth weight infants,vLBwI)肠道喂养延迟的近期临床结局和围生期因素与VLBWI肠道喂养延迟的关系.方法 选取2007年1月至2011年10月入住我科的355例VLBWI为研究对象,根据生后肠道喂养开始时间分为两组:延迟喂养组57例(开奶时间≥5 d)和早期喂养组298例(开奶时间≤4d),并比较住院天数＞14d、治愈或好转出院的299例VLBWI近期临床结局(包括延迟喂养组44例和早期喂养组255例).采用单因素和多因素Logistic回归对VLBWI的围生期高危因素进行分析.结果 355例VLBWI喂养延迟发生率为16.05％ (57/355).延迟喂养组患儿恢复到出生体重的时间明显长于早期喂养组[(11.86±3.86) dvs (9.76±3.83)d,P＜0.01].延迟喂养组患儿合并静脉营养相关性胆汁淤积症和出院时宫外发育迟缓的比例为27.27％(12/44)和79.55％ (35/44),亦明显高于早期喂养组[分别为11.76％(30/255)和61.57％(157/255),P＜0.05)].多因素Logistic回归分析显示,胎盘早剥和机械通气增加了VLBWI生后肠道喂养延迟的风险(OR =2.74,95％ CI 1.06 ～7.05;OR =3.51,95％ CI 1.92～ 6.42,P＜0.05).结论 胎盘早剥和机械通气是VLBWI生后肠道喂养延迟的独立危险因素.加强产前保健及产儿合作是改善早产儿结局、减少肠道喂养延迟的关键.     

61例极低出生体重早产儿生后第一年生长发育的随访

目的 探讨极低出生体重早产儿生后第一年生长发育情况及相关影响因素。方法 对61例极低出生体重早产儿进行出生后第一年的生长发育监测。采用Z评分法评价体格指标、丹佛发育筛查测验(DDST)进行发育筛查。结果 61例中小于胎龄儿(SGA)27例(44.3%),适于胎龄儿(AGA)34例(55.7%)。随访1年,年龄别体重(WAZ)、年龄别身长(HAZ)、年龄别头围(HCZ)、身长别体重(WHZ)的Z积分中位数均>-1 SD;年龄别体质指数(BMI)的Z积分(BAZ)以及WHZ的高峰在纠正年龄1个月。纠正胎龄40周时,低体重、生长迟缓、消瘦、小头畸形、超重和肥胖等的生长偏离发生率最高,分别为15%、16%、11%、13%、20%和10%。与纠正胎龄40周比,纠正年龄6个月及9~12个月的超重发生率(3%,3%)明显降低(P P 结论 极低出生体重早产儿在纠正龄3个月以内生长偏离明显。生后第一年DDST筛查异常的比例较高。     

母乳喂养质量改进对极低和超低出生体重儿亲母母乳喂养率的影响

目的 探讨NICU 中母乳喂养质量改进措施对极低和超低出生体重儿亲母母乳喂养率的影响。方法 回顾性调查收集2014 年7 月至2015 年7 月收治的极低和超低出生体重儿（质量改进前组）以及实施母乳质量改进措施后的2015 年8 月至2016 年6 月的极低和超低出生体重儿（质量改进后组）资料。对两组患儿住院期间亲母母乳喂养情况（喂养率、喂养量、喂养时间）、静脉营养持续时间、达到全肠道喂养的时间,喂养不耐受发生率等指标进行比较。结果 实施质量改进后,亲母母乳喂养率和喂养量均明显增高,母乳强化剂添加时间、静脉营养时间、达全肠道喂养时间均较改进前提前,喂养不耐受的发生率较改进前有所改善,差异有统计学意义。结论 亲母母乳喂养质量改进措施可提高NICU 亲母母乳喂养率,改善早产儿消化系统相关并发症。     

极低出生体重儿肠外营养相关性胆汁淤积高危因素分析

目的：胆汁淤积是婴儿肠外营养最常见的并发症,本研究旨在调查极低出生体重儿长期肠外营养相关性胆汁淤积的高危因素。方法：回顾性分析2006年8月至2011年12月在重症监护室住院且肠外营养时间大于2周的极低出生体重儿204例,使用营养液前后定期检测肝功能,发生胆汁淤积的观察组和未发生胆汁淤积的对照组进行单因素及多因素分析。结果：204例极低出生体重儿发生胆汁淤积46例（22.5%）;单因素分析显示经鼻持续正压通气（CPAP）、呼吸衰竭、呼吸窘迫综合征、支气管肺发育不良及早产儿视网膜病在观察组的比例明显高于对照组;另外,与对照组相比,观察组出生体重低、吸氧时间长、第一次开奶时间晚、禁食时间长、肠外营养持续时间长、总氨基酸和总脂肪的摄入量高。Logistic回归分析显示禁食时间（OR:1.115,95%CI： 1.031~1.207）是胆汁淤积的高危因素。结论：胆汁淤积的发生是多因素的,危重儿尽早开展肠内营养,减少肠外营养时间,降低胆汁淤积的发生。     

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超低出生体重儿(extremely low birth weight infant,ELBWI)是指出生体重低于1000g的新生儿,大多为胎龄小于32周的极早产儿[1]。伴随围生期医学和新生儿医学的不断发展,ELBWI出生率不断上升,可能存活者的体重和孕周不断降低。     

极低出生体质量儿支气管肺发育不良的临床高危因素分析

目的 探讨极低出生体质量儿发生支气管肺发育不良(bronchopulmonary dysplasia,BPD)的临床高危因素.方法 回顾性分析2006年9月至2009年9月我院NICU收治的49例极低出生体质量儿的临床资料,分为BPD组(n=15)和非BPD组(n=34),分析BPD发生的可能危险因素.结果与非BPD组相比,BPD组患儿在胎龄[(29.30±1.48)周vs(30.54±1.60)周]、院内获得性感染(9例vs 10例)、宫内感染(9例vs 8例)、持续气道正压通气时间[(12.47±5.83)d vs(4.24±4.19)d]、高浓度氧疗时间[(1.47±1.41)dvs(0.18±0.63)d]、动脉导管未闭(5例vs 1例)等方面比较,差异有统计学意义(P均＜0.05).Logistic回归分析结果显示持续气道正压通气时间以及宫内感染是极低出生体质量儿发生BPD的高危因素(P＜0.05).结论 预防宫内感染可降低BPD的发生率和严重程度,长时间的持续气道正压通气可能预示早期BPD的发生.     

Fluconazole prophylaxis prevents invasive fungal infection in high-risk, very low birth weight infants

OBJECTIVES: To evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight (VLBW) infants with central vascular access. STUDY DESIGN: A 3-year baseline period (1998 to 2000) was compared with a subsequent 3-year period (2001 to 2003) during which a different protocol for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fluconazole (Diflucan R) was administered for 28 days at a dose of 6 mg/kg every third day during the first week and daily after the first week. RESULTS: There were no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infection developed in 9 of the infants in the baseline group and in none of those in the fluconazole group (P=.003). A trend of decreasing mortality rate between the 2 groups (12.6% vs 8.1%; P=.32) was observed but was not statistically significant. No adverse effects of fluconazole therapy were documented. CONCLUSIONS: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.     

极低出生体质量儿远期神经系统发育状况的研究

极低出生体质量儿(very low birth weight,VLBW)的出生率逐年增高,其存活率也随着NICU先进技术的发展日益上升,但VLBW的预后已成为社会关心的问题.近年来越来越多的研究证实,与足月儿相比,VLBW脑结构改变主要表现为脑容积、脑灰质容积和脑白质减少.因此,部分VLBW在儿童期出现了神经系统发育障...     

Neurodevelopmental outcomes of very low birth weight and extremely low birth weight infants at 18 months of corrected age associated with prenatal risk factors

Background

Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes.

Aim

To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants.

Study design

The study design is a retrospective review.

Subjects

One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500 g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants.

Outcome measures

Infants' neurodevelopmental outcomes at 18 months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups.

Results

Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31 weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group.

Conclusion

In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed.     

Excessively high bilirubin and exchange transfusion in very low birth weight infants

Aim: To evaluate the performance of exchange transfusion in very low birth weight (VLBW) infants with excessively high serum bilirubin levels. Methods: A population‐based observational study using data collected by the Israel National VLBW Infant Database. The study sample comprised 13 499 infants. Two definitions of excessively high‐peak bilirubin levels that might be considered as threshold levels for performance of exchange transfusion were used. First, a bilirubin level of ≥15 mg/dL for all infants (PSB‐15), and second, incremental bilirubin levels ranging from 12 to 17 mg/dL according to gestational age (PSB‐GA). Results: Four hundreds sixty‐eight (3.5%) and 1035 infants (7.7%) infants in the PSB‐15 and in the PSB‐GA groups respectively had peak serum bilirubin levels above thresholds for exchange transfusion. Exchange transfusions were performed in 66 (14.1%) of these infants in the PSB‐15 group and 91 (8.8%) in the PSB‐GA group. Using logistic regression analysis, peak serum bilirubin was found as an independent factor for performing exchange transfusion. Conclusion: Exchange transfusion was performed in only 9–14% of VLBW infants with excessively high bilirubin levels. We speculate that this may be a result of an absence of definitive guidelines or the possible belief that the risks of exchange transfusion outweigh the potential risk of bilirubin‐induced neurological injuries.