Construction of nursing quality evaluation system for neonatal blood exchange transfusion / 中国实用护理杂志

Objective To compose a scientific, systematic and operative nursing quality evaluation system for neonatal blood exchange transfusion, and to provide a reference for quality control of clinical nursing practice. Methods Semi-structured interviews were conducted, the related literature was reviewed, and a preliminary Delphi enquiry questionnaire with the frame of structure quality, process quality and outcome quality was ultimately formed. Through Delphi enquiry questionnaires and analytic hierarchy processing method, all the indictors and the weights were affirmed. Results Totally 19 experts participated in the inquiry, the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively, theχ2 test of Kendall′s W coefficients was significance with P<0.01. The nursing quality evaluation system for neonatal blood exchange transfusion was finalized with 3 level-1 indicators, 9 level-2 indicators and 39 level-3 indicators. Conclusions The nursing quality evaluation system developed through this study can provide practical reference to clinical nursing practice.

Clinical analysis on blood exchange transfusion in treating 142 cases of neonatal severe hyperbilirubinemia / 国际检验医学杂志

Objective To explore the cause constituents of neonatal severe hyperbilirubinemia and the clinical efficacy and safety of blood exchange transfusion treatment .Methods 142 neonates with severe hyperbilirubinemia conducted the blood exchange transfusion therapy .The levels of serum total bilirubin ,indirect bilirubin and direct bilirubin and the change of blood routine indica-tors were analyzed before and after blood exchange transfusion .Results The main causes leading to neonatal severe hyperbilirubi-nemia were bacterial infection(28 .20% ) ,glucose-6-phosphate dehydrogenase(G6PD) deficiency(27 .50% ) and pregnant women with ABO blood group incompatibility (16 .20% ) .The levels of serum total bilirubin ,indirect bilirubin ,direct bilirubin and blood routine indicators after operation in neonates with severe hyperbilirubinemia were significantly lower than those before operation , the differences were statistically significant (P<0 .05) .The total bilirubin swap exchange was (54 .40 ± 9 .90)% .The intraoperative adverse reactions rate was 3 .50% .The postoperative thrombocytopenia occurrence rate was 72 .00% .Conclusion The blood ex-change transfusion for treating neonatal severe hyperbilirubinemia possesses has clinical significance ,but the hematology and bio-chemical indicators monitoring should be strengthened for avoiding adverse reactions occurrence .

Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency / 소아과

PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients. RESULTS: Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03). CONCLUSION: G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.

A Follow-up Study of Newborns who had Exchange Blood Transfusion for Hyperbilirubinemia

A follow up study was made of 59 cases of neonatal hyperbilirubinemia receving blood exchange transfusion at Kwangju Christian Hospital from early 1976 to early 1979, with the following results. 1. 42patients(71.2%) returned for followup: 12 patients(20.3%) did not return; and 5 patients(8.5%) had died. 2. Of those returning, developmental status was studied by D.D.S.T. 38 patients(90.5%) had normal development , 3(7.1%) were retarded, and 1(2.4%) was questionable. 3. There was no retardation among patients exchange-Transfused at the age of 5 days or less, except for one patients with severe dehydration. All the other retarded or dying patients were over 5 days at the time of exchange transfusion. 4. Serum bilirubin level was above 27 mg% in all retarded patients . Of the 5 patients dying, 3 had serum bilirubin levels of over 40mg%, one with S.B. of 25mg% had BET at 10 days of age, and one died of necrotizing enterocolitis without evidence of kernicterus. 5. In patients with normal development, 23 were male, and 15 were female. All females had normal development, whereas all four babies with retardation were male. 6. Because S.B. remained over 25mg%, three patients underwent a second BET, with good results. 7. ABO incompatibility was etiologically responsible in 23 cases (55.9%), followed by idiopathic hyperbilirubinemia in 16 cases (27.4%), Other causes of hyperbilirubinemia were infection, respiratory distress syndrome, immune neonatal thrombocytopenia, enclosed hemorrhage, small-for-date infant, etc. 8. Mean values with standard errors of pre BET serum bilirubin level were as follows. Normal development group: 28.10.69mg% Retarded development group: 30.21.15mg% There was a tendency toward higher S.B. levels in retarded development group. 9. Nine patients who had early signs of kernicterus on admission, developed normally after BET, but those patients , shown later to be retarded, had only transient improvement of early signs of kernicterus at the time of discharge. 10. Thirty-three patients had siblings, among whom 8 also had history of hyperbilirubinemia or mental retardation due to kernicterus, or had undergone blood exchange transfusion. All of the were cases of ABO incompatibility. 11. Motor distrubance was the predominant handicap in all 4 cases of typical cerebral palsy, but no speech disturbance or hearing loss was seen. Choreoathetosis was evident in two patients over 3 years of age, but it was not possible to classify the cerebral palsy in two patients less than 1 1/2years of age.