ABSTRACT
Objective To observe the effect of peripheral arteriovenous exchange combined with intravenous gamma globulin in the treatment of neonatal hemolysis. Methods Seventy children with neonatal hemolysis admitted to the first affiliated Hospital of China Medical University from January 2013 to May 2018 and who met the indications for peripheral arteriovenous exchange were selected as the study subjects. The patients were divided into peripheral arteriovenous exchange group and ＂peripheral arteriovenous exchange+gamma globulin＂ group by random number table method,with 35 cases in each group. Baseline data of the two groups, changes of serum bilirubin before and after treatment, partial blood biochemical indicators, hospitalization time and jaundice regression time were observed. Results The levels of serum bilirubin ((241. 5±48. 1),(184. 6± 26. 3),(166. 3± 18. 5),(133. 5± 20. 8) μmol／L) in peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in peripheral arteriovenous exchange group ((299. 3±32. 5),( 225. 7± 38. 9),(195. 4± 21. 1),( 173. 8± 35. 4) μmol／L) at 12,24,48 and 72 hours after treatment,the difference was significant (P＜0. 05). RBC in children in two groups after treatment was(4. 3±0. 8)×1012／L,(4. 2±1. 0)×1012／L vs. before(5. 2±1. 1)×1012／L,(6. 4±1. 3)×1012／L,Hb after treatment in both groups was (125. 8 ± 11. 2) g／L,( 124. 9 ± 10. 5) g／L vs. before ( 148. 9 ± 26. 5) g／L, (159. 3±14. 6) g／L and reticulocyte count after treatment in both groups were (7. 6±2. 1)%,(7. 3±1. 8)%vs. ( 5. 2 ± 1. 3)%, ( 3. 1 ± 0. 5)% were significantly improved, but the peripheral arteriovenous exchange+gamma globulin group was significantly better than the peripheral arteriovenous transfusion group, the difference was statistically significant ( all P＜0. 05) . The hospitalization time (10. 3±1. 9) d and jaundice regression time ( 8. 6 ± 0. 5) d in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than those in the peripheral arteriovenous exchange group ((15. 5±2. 6) d,(10. 0±1. 1) d) . The difference was statistically significant ( t＝ 9. 553, 6. 855, P＜0. 05) . The children who had re-hemolytic after treatment in the peripheral arteriovenous exchange + gamma globulin group were significantly lower than the peripheral arteriovenous exchange group ( 5. 7%( 2／35) vs. 25. 7%(9／35)),the difference was statistically significant ( χ2 ＝ 5. 285, P ＝ 0. 022 ) . Conclusion Peripheral arteriovenous exchange combined with intravenous gamma globulin is effective in the treatment of neonatal hemolysis. It can significantly reduce serum bilirubin,improve blood biochemical parameters,shorten hospitalization time and jaundice regression time,and is safe and reliable.
ABSTRACT
Objective To analyze the changes of electroencephalographic activities during fully automated simultaneous peripheral arteriovenous exchange transfusion(ET) in neonates with hyperbilirubinemia.Methods A total of 45 neonates who suffered from severe hyperbilirubinemia and underwent fully automated simultaneous peripheral arteriovenous exchange transfusion were studied from March 2009 to March 2016 in Neonatal Intensive Care Unit of Guangzhou Women and Children's Medical Center,and 46 ETs were performed in 45 babies who were divided into 2 groups according to the severity of hyperbilirubinemia:the encephalopathy group and the none-encephalopathy group.Nineteen patients were in the encephalopathy group,in which 11 were male and 8 were female.The other 26 patients were in the none-encephalopathy group,in which 15 were male and 11 were female.Changes in amplitude integrated electroencephalogram(aEEG) during ETs were analyzed,including background activities,sleep-wake cycle (SWC)and seizures.Results Forty-five patients with hyperbilirubinemia underwent 46 fully automated simultaneous peripheral arteriovenous ETs.As a result,total bilirubin dropped from (524.90 ± 110.96)μmol/L before ETs to (245.62 ±78.97) μmol/L after ETs,with clearance rate of 53.2％.And indirect bilirubin dropped from(486.16 ±90.39) μmol/L before ETs to(222.19 ± 79.49) μmoL/L after ETs,with clearance rate of 54.3％.On the other hand,there was no significant difference in the changes of electroencephalographic activities during ETs,including background activities (x2 =0.16,P ＞ 0.05),SWC (x2 =0.71,P ＞ 0.05) and seizures (x2 =0.30,P ＞ 0.05).However,there were significant difference in suppressions on background activities between the encephalopathy group and the none-encephalopathy group(Fisher's exact test P =0.042),though there were no significant statistical differences in SWC or seizures between the 2 groups (x2 =0.65,P ＞ 0.05;x2 =2.07,P ＞ 0.05,respectively).Conclusions In neonatal hyperbilirubinemia,fully automated simultaneous peripheral arteriovenous ET is safe and efficient without significant influence on electroencephalographic activities as a whole.However,background activities are more significantly depressed in infants of bilirubin encephalopathy than that of non-encephalopathy during ET.
