Complications and outcome of exchange blood transfusion neonatal unconjugated hyperbillirubinemia

Neonatal jaundice is a common neonatal problem, usually have a benign course however in certain unmonitored and untreated conditions, unconjugated hyperbillirubinemia can progress to acute bilirubin encephalopathy, exchange blood transfusion although rarely used now in developed countries still commonly used in developing countries. To assess complications of exchange blood transfusion [EBT] for hyperbillirubinemia, also to study its incidence with exploration of cases with Kernicterus in neonatal intensive care unit [NICU], new children hospital Cairo University. A retrospective study in the NICU, new children hospital Cairo University, where data of all cases with neonatal hyperbillirubinemia who were underwent [EBT] over one year starting the first of January-end of December 2007 were collected from patients files and analyzed. EBT accounted for [30.9%] of NICU cases with neonatal jaundice, 43.8% were females and 56.2% were males, 72.6% delivered by NVD with mean gestational age 37.36 +/- 1.67 weeks, the mean age at presentation was 5.4 days +/- 2.9 [1-20] and the mean body weight was 2.73 +/- 0.54kg. ABO incompatibility accounted for 51.9% of causes of jaundice and no cause can be determined in 27.4% of cases, Kernicterus was recorded in 18 cases 8.6%, pre-exchange bilirubin level was the most important determinant factor with [p value 0.000]. Complications of EBT included hypoglycaemia. [10.09%], hypocalcaemia [25.5%], hyponatremia [6.3%], hypernatremia [3.84%], Hypokalemia [5.3%] and hyperkalemia [5.3%]. Thrombocytopenia was recorded in [28.36%[, cholestasis in [9.6%]. NEC [0.5%], sepsis [18.3%]. Mortality was recorded in 14 cases [6.7%] and it was correlated with GA and age at presentation with [p value 0.03] for both, mortality was more common among kernicteric group with [p value 0.02]. Incidence of neonatal jaundice among NICU is high exchange blood transfusion was done more frequently which could be explained by relative late presentation with high mean bilirubin level causes of severe neonatal hyperbillirubinemia were undetermined in 27.4% complication of EBT included, electrolytes disturbances, thrombocytopenia and cholestasis, major complications included NEC, sepsis and death. Kernicterus still recorded in NICU with bad outcome and the most important determinant factor for it is a pre-exchange bilirubin level

Benefits and harms associated with hormone replacement therapy: clinical decision analysis

To evaluate harms and benefits associated with use of combined hormone replacement therapy [HRT] for five years in women with different baseline risks for breast cancer. Probabilistic clinical decision analysis. Population of women aged 50 years with different baseline risks for breast cancer. Gain or loss in quality adjusted life years [QALYs]. Women free of menopausal symptoms showed a net harm from HRT use, which increased for increasing baseline risk of breast cancer. Those with a baseline risk of 1.2% would expect a loss in QALYs of 0.4 months [-0.03 QALYs, 95% credibility interval -0.05 to -0.01]. The main analysis showed HRT to be on average beneficial in women with symptoms, with benefit decreasing with increasing baseline risk of breast cancer. The results were sensitive to the assumed value of quality of life with menopausal symptoms; therefore a contour plot was developed to show the probability of net harm for a range of different values and baseline risks. HRT for primary prevention of chronic diseases in women without menopausal symptoms is unjustified. Perceived quality of life in women with symptoms should be taken into account when deciding on HRT. Thus, a decision analysis tailored to an individual woman is more appropriate in clinical practice than a population based approach