Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.@*METHODS@#This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.@*RESULTS@#A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.@*CONCLUSIONS@#In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.

Effects of exchange transfusion and phototherapy on neonatal thyroid functions

Hyperbilirubinemia is one of the most common problems encountered in term newborns. Phototherapy or exchange transfusion may be indicated for treatment at certain bilirubin levels. Aim of the work: Is to study the effects of exchange transfusion and phototherapy on thyroid functions in full term neonates with indirect hyperbilirubinemia by assessing thyroid functions before and after exchange transfusion and during phototherapy. The present study was carried on 60 full term neonates who were grouped as follows: Group I: Included 20 neonates with hyperbilirubinemia reaching the level that indicated exchange transfusion. Group II: included 20 neonates with hyperbilirubinemia at the level of treatment by phototherapy. Group Ill: included 20 healthy neonates as a control group. All studied groups were subjected to full medical history, clinical examination and laboratory investigations including Free T3, Free T4, TSH before, immediately after and 4 days after exchange transfusion in group I, Free T3, FreeT4, TSH before and 2 days after the beginning of phototherapy in group II, Free T3, Free T4, TSH in group Ill, Free T3, T4, and TSH levels were assessed in donor blood bags prepared for exchange transfusion. In addition liver function tests, complete blood count, Coombs' test, C reactive protein, blood group of baby and mother were assessed for neonates in group I and II. We found that the levels of thyroid functions [FT3, FT4, TSH] were statistically significantly higher in neonates before exchange transfusion than immediately after exchange while there was no statistical significant difference in levels of thyroid functions before exchange transfusion and 4 days post exchange transfusion. Furthermore, the study revealed no significant differences between thyroid function tests before and during phototherapy. Moreover, there were no significant correlations between thyroid function tests and either bilirubin or hemoglobin levels of group I before exchange transfusion and group II before phototherapy. We found that exchange transfusion causes a decrease in thyroid functions immediately after exchange than before exchange and they return to normal levels four days post exchange. On the other hand, phototherapy does not affect thyroid function tests

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

Cytomegalovirus infection in neonates following exchange transfusion.

OBJECTIVES: This study was undertaken to ascertain the acquisition of cytomegalovirus infection following exchange transfusion and factors affecting such transmission in newborn infants at a tertiary care hospital in India. METHODS: Neonates undergoing double volume exchange transfusion (for any indication) with whole blood in the Neonatal Intensive Care Unit were enrolled over a 8 month period. Serum samples from the infant were collected for CMV serology before exchange transfusion, and at 6 and 12 weeks following the exchange. CMV serology was also conducted on samples obtained from the respective maternal and donor blood. RESULTS: Of 47 neonates who received exchange transfusion during the study period; only 26 (55.3%) neonates were finally followed up till 12 weeks of age. Only 3 (11.5%) children demonstrated CMV seroconversion during follow-up; all were low birth weight and small for gestational age. None of them demonstrated any clinical, hematological, biochemical, or radiological signs suggestive of perinatal CMV infection either at birth or during the course of follow-up. CONCLUSION: Exchange transfusion in neonates can result in perinatal transmission of CMV infection in low birth weight neonates. Such transmission does not result in any immediate manifestations. Data are not sufficient to warrant routine CMV screening of donor blood for exchange transfusion in our setting.

Exchange transfusion and its morbidity in ten-year period at King Chulalongkorn Hospital.

The objectives of this study were to consider the rate of exchange transfusion (ET) in the newborns at King Chulalongkorn Hospital, Bangkok, from 1994 to 2003, and to evaluate its morbidity and mortality. One hundred and sixty five neonates underwent 183 episodes of ET: In-housed fullterm had ET performed at a younger age than the readmitted/referred infants (72.2 +/- 30.9 vs 150.2 +/- 90.7 hours, p < 0.001), and the in-housed preterm neonates (85.4 +/- 36.7 hours, p < 0. 05). They also had lower mean TsB than those of the readmitted/referred infants when ET was initiated (21.8 +/- 2.1 vs.26. 0 +/- 5.1 mg/dL, p < 0.001). Preterm needed phototherapy after ET longer than fullterm neonates (5.3 +/- 3.2 vs 3.3 +/- 1.7 days, p < 0.001). ABO incompatibility (21.3%), G6PD deficiency (13.4%), both conditions (6.7%), and others (22.2%) were identified as causes of hyperbilirubinemia. Unknown causes accounted for 36.4%. There was no mortality in the present study. Overall rate of morbidity was 15.3% of which 67 percent was infection associated conditions. Preterm suffered additional complications of anemia, apnea and cardiac arrest. Sick infants (31.3%) were more likely to develop complications than healthy ones (6.8%). In the healthy group, preterm were more likely to develop morbidity than fullterm neonates (p = 0.0016), while no significant difference was identified between them in the sick group (p = 0.8). ET causes high morbidity, therefore, it should be initiated only when the benefit of preventing kernicterus outweighs the complications associated with the procedure.

evaluation of cytomegalovirus in infants following exchange transfusion in Children Medical Hospital

During the infancy period, exchange transfusion is the main and effective method of cure for hyperbilirubineamia in hemolytic neonates. One of the risks involved in these patients is CMV infection. Since CMV can inflict and kill children with immunodeficiency, we decided to evaluate blood transmitted CMV infection in infants for the first time in Iran. In this prospective study, the levels of IgG and IgM antibody against CMV in infants blood sera before and after exchange transfusion, sera of their mothers, and the plasma of donors were evaluated by ELISA method and conventional kits. The data were then analyzed by nonparameteric and mac nemar test. The level of specific IgM antibody of CMV was 14% in the serum of infants before exchange transfusion and 48% two months after exchange which came out to be significant [p<0.0001]. This indicates transmittability of CMV infection through blood transfusion since the amount of primary infection of CMV in mothers [IgM] was only 1%. According to the high level of CMV infection in infants [14%] compared to mothers [1%], it can be concluded that some mothers have latent CMV infection. On the other hand, the high level of CMV infection in infants [48%] 2 months after transfusion is caused by post-transfusion CMV infection. Analysis of the data obtained from dependent varibles such as volume of transfused blood, number of exchange transfusion attempts, weight, age, sex and blood group analyzed by the nonpara-meteric method indicated that the volume of transfused blood to infants has a direct correlation with the rate of transmission of infection to them but other variables do not have any correlation

Exchange transfusion in neonatal hyperbilirubinemia.

Four hundred and thirty three exchange transfusions (ET) for neonatal hyperbilirubinemia in 225 full term (Group I) and 110 premature/low birth weight (Group II) babies were analyzed. A total of 78.5% cases required one, 15.22% two, 4.8% three and 1.5% four ET. In Group I ABO HDN (35.94%), Rh HDN (10.7%), septicemia (8.9%), and G-6-PD deficiency (6.2%) were the major causes. Nearly 20% had multiple factors and in 9.3% no cause was identified. In multifactorial cases 13.3% had septicemia, 17.3% ABO HDN and 6.2% Rh HDN in various combinations. Common causes in Group II babies were septicemia (20.9%), ABO HDN (19.07%), Rh HDN (6.4%) and G-6-PD deficiency (5.4%). Nearly 8% had multifactorial etiology while 30.9% were idiopathic. Complications occurred in 20.4% Group I and 41.8% in Group II babies during ET. Procedure related mortality was 3.2/100 ET which declined to 0.9/100 ET when high risk babies were excluded. Overall mortality in babies subjected to ET was 10.6/100 ET. Cardiorespiratory arrest during procedure (30.4%), septicemia (26.1%) and kernicterus (19.6%) were the leading causes of death. Anemia (23.5% Group I and 50.9% Group II babies) and clinical septicemia (14.2% Group I and 16.4% Group II babies) were major delayed complications.

Exsanguinotransfusión en hiperbilirrubinemia neonatal: complicaciones y letalidad / Exchange transfusion in neonatal hyperbilirubinaemia: complications and lethality

En el presente trabajo se evalúan las complicaciones y mortalidad que se presentaron en 320 exsanguinotransfusiones (ET) practicadas. El procedimiento se realizó en el 83% de los casos a través del cateterismo de vasos umbilicales y en el resto por disección quirúrgica de un vaso central o umbilical.Las complicaciones inmediatas más frecuentes fueron sangrado (2.5%). arritmia cardiaca (1.6%) y apnea prolongada (1.2%). De las tardías la más frecuente fue onfalitis (3.4%), seguida de enterocolitis necrosante (1.2%). En el 98.1% de los casos se logró finalizar la ET. Su letalidad global fue de 1.8%. la cual se observó en seis pacientes pretérmino con pesos menores de 2000 g y padecimientos asociados graves. La mortalidad fue simular a la de trabajos previos, habiendo participado en la realización de los procedimientos el personal médico residente. La letalidad por ET disminuyó en el mismo Servicio, lo cual es una tenedencia general y se atribuye a la mayor comprensión de la disiopatologia neonatal y el mejor cuidado de los recién nacido gravemente enfermos. Muchas de las complicaciones son previsibles