Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia

The jaundice chapter illustrates how to stabilize newborns with hyperbilirubinemia—a common condition—and avoid their developing severe hyperbilirubinemia. Prevention is accomplished by transcutaneous bilirubin testing, total serum bilirubintests, and the use of nomograms to evaluate risk for hyperbilirubinemia and direct appropriate care. Specific risk factors for jaundice and hyperbilirubinemia, treatment thresholds for phototherapy treatment or exchange transfusion, and a bilirubin-induced neurological dysfunction scoring tool for assessing severity in acute bilirubin encephalopathy cases are included. Related procedures, such as the direct antiglobulin test, volume expansion, and intravenous immunoglobulin administration are described. Focal skills, such as plotting and interpreting the nomograms, are applied in the case scenario.

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Relationship research between auditory neuropathy spectrum disorder and exchange transfusion in neonates with severe hyperbilirubinemia

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2019.04.044 ◽

2019 ◽

Vol 123 ◽

pp. 146-150

Author(s):

Jie Xu ◽

Meiling Weng ◽

Nianqiong Li ◽

Xiu'e Wu ◽

Li Gao ◽

...

Keyword(s):

Exchange Transfusion ◽

Auditory Neuropathy ◽

Spectrum Disorder ◽

Auditory Neuropathy Spectrum Disorder ◽

Severe Hyperbilirubinemia

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Sn-Mesoporphyrin Interdiction of Severe Hyperbilirubinemia in Jehovah's Witness Newborns as an Alternative to Exchange Transfusion

PEDIATRICS ◽

10.1542/peds.108.6.1374 ◽

2001 ◽

Vol 108 (6) ◽

pp. 1374-1377 ◽

Cited By ~ 33

Author(s):

A. Kappas ◽

G. S. Drummond ◽

D. P. Munson ◽

J. R. Marshall

Keyword(s):

Exchange Transfusion ◽

Jehovah’S Witness ◽

Jehovah's Witness ◽

Severe Hyperbilirubinemia

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Can exchange transfusion be replaced by double-LED phototherapy?

Open Medicine ◽

10.1515/med-2021-0320 ◽

2021 ◽

Vol 16 (1) ◽

pp. 992-996

Author(s):

Shinya Abe ◽

Kazumichi Fujioka

Keyword(s):

Exchange Transfusion ◽

Light Emitting Diode ◽

Safe Procedure ◽

Light Emitting ◽

Safety Issues ◽

Led Phototherapy ◽

Recent Developments ◽

Good Treatment Strategy ◽

Severe Hyperbilirubinemia

Abstract Phototherapy is a conventional treatment for neonatal jaundice and widely considered as a safe procedure. Recent developments in light-emitting diode (LED) phototherapy devices have made more effective treatments possible. Exchange transfusion (ET) is typically applied for cases of refractory severe hyperbilirubinemia despite its risk of various complications. Since the therapeutic effect of phototherapy is correlated with its irradiance, ET may be avoided by performing phototherapy with higher irradiation. Recently, we adopted double-LED phototherapy as a bridging treatment to ET to treat a case of severe hyperbilirubinemia. In this case, the continual increase of bilirubin levels was suppressed immediately after its administration, and ET was not required. Throughout the treatment, no complications or increase in oxidative stress was observed. In addition, neurodevelopment was appropriate for the patient’s age at the 1-year follow-up, and no findings of kernicterus, including physical and magnetic resonance imaging findings, were observed. We hypothesized that double-LED phototherapy may be a good treatment strategy to replace ET for infants with severe hyperbilirubinemia; however, further investigations regarding safety issues including acute and long-term complications are needed before clinical adaptation.

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Developmental outcome of severe neonatal indirect hyperbilirubinemia

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2021.001 ◽

2021 ◽

Vol 9 (1) ◽

pp. 1-1

Author(s):

Manizheh Mostafa Gharehbaghi ◽

Seifolah Heidatabady ◽

Masoomeh Ghasempour ◽

Mahsa Alizade

Keyword(s):

Exchange Transfusion ◽

Neonatal Period ◽

Neurodevelopmental Outcome ◽

Total Serum ◽

Term Infants ◽

Abo Incompatibility ◽

Ages And Stages Questionnaire ◽

Classic Form ◽

Sensory Neural ◽

Severe Hyperbilirubinemia

Background: Indirect hyperbilirubinemia is one of the most common causes of hospitalization in the neonatal period and its potential association with brain damage is well established. This study was conducted to determine neurodevelopmental outcome of children who had severe indirect hyperbilirubinemia in neonatal period and received intensive phototherapy with or without double volume exchange transfusion for its management. Material & methods: This descriptive analytical study was performed in healthy infants with the history of severe indirect hyperbilirubinemia and need intensive phototherapy with or without exchange transfusion. We invited the enrolled infants at their 2-3 years age. Neurodevelopmental assessment was performed by a trained nurse using Ages and Stages Questionnaire. Results: The mean total serum bilirubin (TSB) of studied children was 26.4±4.1 mg/dl at their neonatal period. The estimated rate of severe hyperbilirubinemia with the TSB of 25-30 mg/dl was 48.7/100,000 live born infants and 11.4 /100,000 for hyperbilirubinemia higher than 30 mg/dl. The most common cause of jaundice in patients with exchange transfusion was ABO incompatibility. At their follow up examination, the classic form of bilirubin induced encephalopathy (Kernicterus) was diagnosed in 3 neonates. Two of them had sensory neural hearing loss too. Eleven children had low score based on ASQ in at least one area. The score was less than 2SD in 3 patients. Conclusion: Severe hyperbilirubinemia and kernicterus is still occurring in term and late pre-term infants. Early detection and management of severe hyperbilirubinemia may improve the neurodevelopmental outcome in high risk infants.

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19 Treatment of Neonatal Hyperbilirubinemia – Ontario Cohort 2014-2018

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.018 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e7-e7

Author(s):

Saisujani Rasiah ◽

Thivia Jegathesan ◽

Douglas Campbell ◽

Michael Sgro

Keyword(s):

Exchange Transfusion ◽

Cochrane Review ◽

Ivig Therapy ◽

Population Based ◽

Significant Rise ◽

Neonatal Hyperbilirubinemia ◽

Term Infants ◽

Near Term ◽

Almost All ◽

Severe Hyperbilirubinemia

Abstract Background Serious complications that could result from severe neonatal hyperbilirubinemia include acute and chronic bilirubin encephalopathy. In Ontario, the incidence of severe neonatal hyperbilirubinemia and its associated treatments in term and near-term infants is currently unknown. Although IVIG therapy has been increasingly discussed in the literature, a recent Cochrane review (2018) indicated that there was a lack of evidence for recommending IVIG therapy for routine use. Objectives The purpose of this study was to determine the current incidence of severe neonatal hyperbilirubinemia and its treatments (Intravenous Immunoglobulin (IVIG) therapy, exchange transfusion and phototherapy) most often used in Ontario. Design/Methods A population-based retrospective cohort study of all term and near-term infants (≥ 35 weeks’ gestation) born in Ontario from April 2014 to March 2018 was conducted. National and provincial databases including Better Outcomes Registry Network Ontario (BORN) and Canadian Neonatal Network (CNN) were utilized. Results Data was collected from 533,084 infants born in Ontario over the 4 years. Of the total infants screened, 29,756 (6%) infants were diagnosed with neonatal hyperbilirubinemia. In terms of treatments, 24,646 (83%) infants received phototherapy, 54 (0.18%) infants received an exchange transfusion and 458 (1.5%) infants received IVIG therapy. In Ontario, neonatal hyperbilirubinemia had a statistically significant increase from 2014 to 2018 (P<0.0001). Although phototherapy was used on almost all neonates with hyperbilirubinemia (83%) there was a significant decrease from 2014 to 2018 (from 88% to 80%) (P<0.0001). Of the babies with hyperbilirubinemia in 2014, 71 (1.06%) infants received IVIG therapy and 15 (0.22%) infants received exchange transfusion. Within 4 years, IVIG therapy incidence had a significant increase from 71 (1.06%) infants to 156 (2.04%) infants (P<0.0001), while exchange transfusion remained relatively constant (P=.315). Exchange transfusion rates allows for the prediction that the rate of severe neonatal hyperbilirubinemia is stable in Ontario. Conclusion In conclusion, (severe) hyperbilirubinemia still exists amongst neonates in Ontario, despite the advancements in managing hyperbilirubinemia, indicating the need for better treatments and/or monitoring. There was also a significant rise in the use of IVIG despite the continued debate about its utility. Further research should be conducted nationally to determine the incidence of severe neonatal hyperbilirubinemia and to indicate the usage of IVIG therapy.

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