Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

Our descriptive study examines the clinical profile of referred neonates who underwent exchange blood transfusion (EBT) and identifies possible interventions at peripheral hospitals to decrease their severe hyperbilirubinemia. Among the 38 neonates enrolled, the following were identified as potential clinical gaps in management: early discharge within 24 h of birth (57%); non-availability of ABORh blood grouping (43%); lack of anti-D immunoprophylaxis (75%); pathological weight loss because of inadequate breastfeeding (42%); and low usage of phototherapy. Because of late recognition, the mean age at admission was 5.4 ± 3.3 days, levels of total serum bilirubin (TSB) were 516.4 ± 123.1 µmol/L, and acute bilirubin encephalopathy (ABE) was seen in 45% of neonates. Rh iso-immunisation (39.5%), ABO iso-immunisation (21%) and sepsis (8%) were major risk factors for severe hyperbilirubinaemia. Quality prenatal screening identifying at-risk newborns, preventing early discharge after birth, a bilirubin nomogram risk assignment before discharge and assuring early recognition of hyperbiliubinaemia by parents may well minimise the incidence of EBT.

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Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization

American Journal of Perinatology ◽

10.1055/s-0040-1722328 ◽

2021 ◽

Author(s):

Mahir Tıraş ◽

Emrah Can ◽

Şahin Hamilçıkan

Keyword(s):

Cord Blood ◽

Total Serum ◽

Healthy Controls ◽

Term Neonates ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

Positive Direct ◽

Severe Hyperbilirubinemia

Objective This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. Study Design This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO–DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Results Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. Conclusion COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. Key Points

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G431(P) Neonatal exchange blood transfusion – a 13 month survey in UK and Ireland

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310863.419 ◽

2016 ◽

Vol 101 (Suppl 1) ◽

pp. A254-A255

Author(s):

R Gottstein ◽

J Rennie ◽

S Hannam ◽

A Ryan ◽

H New

Keyword(s):

Blood Transfusion ◽

Exchange Blood Transfusion

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Can Post Exchange Blood Transfusion Haematocrit Be Predicted in Neonates?

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2017.06.00241 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Lamidi I Audu

Keyword(s):

Blood Transfusion ◽

Exchange Blood Transfusion

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Early Neurodevelopmental Outcome of Neonates with Gestation 35 Weeks or More with Serum Bilirubin in Exchange Range Without Encephalopathy: A Prospective Observational Study

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832/11-t-675 ◽

2021 ◽

Vol 40 (2) ◽

pp. 66-72

Author(s):

Deepak Sharma ◽

Rekha Harish ◽

Anuj Bhatti ◽

Radhika Uppal ◽

Jehangir Naseem

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Serum Bilirubin ◽

Neurodevelopmental Outcome ◽

Total Serum ◽

Impaired Hearing ◽

Motor Delay ◽

Bilirubin Encephalopathy ◽

Neurodevelopmental Impairment ◽

Severe Hyperbilirubinemia

ObjectiveTo describe early neurodevelopment outcomes of neonates with severe hyperbilirubinemia without acute bilirubin encephalopathy (ABE).MethodsNeonates born at gestation ≥35 weeks, admitted to NICU with total serum bilirubin (TSB) in exchange range with no features of ABE, were followed up until the age of 6 months. Infants were assessed for impaired hearing and neurodevelopment at 3 months and 6 months of age.ResultsA total of 59 neonates were enrolled in the study. At 3 months of age, 7.6 percent of neonates were found to have hypotonia and motor delay, whereas 42.3 percent had abnormal brainstem evoked response audiometery. At 6 months, 6.4 percent of neonates were found to have persistent neurodevelopmental impairment.ConclusionSevere hyperbilirubinemia is associated with impaired neurodevelopment and hearing even in infants without ABE. Peak TSB level strongly correlates with abnormal outcomes.

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NEONATAL EXCHANGE TRANSFUSION AND CHILDHOOD LEUKEMIA

PEDIATRICS ◽

10.1542/peds.41.6.1128 ◽

1968 ◽

Vol 41 (6) ◽

pp. 1128-1130

Author(s):

Peter J. Dawson ◽

S. Spence Meighan

Keyword(s):

Blood Transfusion ◽

Exchange Transfusion ◽

Childhood Leukemia ◽

The State ◽

Human Leukemia ◽

Viral Etiology ◽

Exchange Blood Transfusion ◽

Neonatal Exchange Transfusion

In a search for evidence of a possible viral etiology for human leukemia, a comparison was made of the incidence of childhood leukemia among babies receiving exchange blood transfusion and those who had no such transfusion. During a 16-year period in the state of Oregon, no difference in the likelihood of contracting leukemia was detected between the two groups.

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Jaundice

ACoRN: Acute Care of at-Risk Newborns ◽

10.1093/med/9780197525227.003.0008 ◽

2021 ◽

pp. 257-288

Keyword(s):

Volume Expansion ◽

Exchange Transfusion ◽

Neurological Dysfunction ◽

Total Serum ◽

Case Scenario ◽

Test Volume ◽

Transcutaneous Bilirubin ◽

Treatment Thresholds ◽

Scoring Tool ◽

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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