Outcomes of rescue exchange transfusion in severe neonatal hyperbilirubinemia

Year 2022, Volume: 47 Issue: 1, 111 - 119, 31.03.2022

Fatih Kılıçbay , Arife Toksöz , Gaffari Tunç

Abstract

Purpose: Urgent treatment in newborns with severe hyperbilirubinemia is the removal of bilirubin from the body by exchange transfusion (ET) as the main treatment modality. The aim of this study was to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two neonatal ıntensive care units (NICUs).
Materials and Methods: The clinical data were collected of 28 newborns who had undergone rescue exchange transfusions after hospitalization with a diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital.
Results: Evaluation was made of 28 newbons with a median serum bilirubin level on admission of 31.2 (20.3-36.8) mg/dL. The leading cause for exchange transfusion was hemolytic jaundice (67.8%), followed by inadequate feeding (14%). The most common cause of hyperbilirubinemia was Rh incompatibility. The reported rate of adverse events associated with exchange transfusion was 71%. The most common complications due to ET were thrombocytopenia and anemia. Four infants died after the ET therapy. Acute bilirubin encephalopathy (ABE) was detected in 39% of the newborns. Serum bilirubin and bilirubin/albumin ratios were found to be high in newborns with ABE.
Conclusion: Newborns with severe hyperbilirubinemia, especially when related to hemolytic jaundice, may need rescue ET. As newborns with severe hyperbilirubinemia with a high bilirubin/albumin ratio are at risk of ABE, ET should be considered in these cases

Keywords

Newborn, Newborn, exchange transfusion, hyperbilirubinemia, acute bilirubin encephalopathy

Supporting Institution

no Funding

Thanks

Dear Editor Please accept this paper and the attached main text, Rescue exchange transfusion in severe neonatal hyperbilirubinemia: a two-center experience", which we would like to submit for possible publication to Çukurova Medical Journal. Urgent treatment in newborns with severe hyperbilirubinemia is removal of bilirubin from the body by exchange transfusion as a main treatment modality. We aimed to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two-NICUs. We collected clinical data of 28 newborns undergone rescue exchange transfusion after hospitalization with diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital Results: The median postnatal age at admission was 3 (1-6) days. The most common cause of hyperbilirubinemia was Rh incompatibility. After ET, serum bilirubin levels, albumin, AST and count of thrombocyte were decreased. The most common complications due to ET were thrombocytopenia and anemia. Acute ABE was detected in 39% of patients. Serum bilirubin and bilirubin / albumin ratios were found to be high in patients with ABE Ethical approval was provided from the Human Research Ethics Committee of Cumhuriyet University before the study, and the study was carried out in accordance with the Helsinki Declaration. Verbal and written informed consents for the study to participation and publication were obtained from patients and their parents, on the condition that patients' anonymity must be preserved. We confirm that this study is original, no conflict of interest related to this study and has not been published elsewhere nor is it currently under consideration for publication elsewhere. We hope that you will afford us the opportunity to be accepted as an author. For any information concerning this manuscript, please contact me preferably by [e-mail] Thank you for your time and consideration of this manuscript. I look forward to hearing from you soon. Yours sincerely, Dr.Fatih Kılıçbay, MD, Division of Neonatology, Department of Pediatrics, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey. Zip Code: 58140. Phone: [phone]/ +90 [e-mail] , Fax: [phone]. E-mail: [e-mail]

Şiddetli neonatal hiperbilirubinemide kurtarma değişimi transfüzyonunun sonuçları

Abstract

Amaç: Şiddetli hiperbilirubinemili yenidoğanlarda bilirubinin vücuttan uzaklaştırılabilmesi için, kan değişimi (KD) acil bir tedavi yöntemidir. İki yenidoğan yoğun bakım ünitesinde (YYBÜ) KD uygulanan şiddetli hiperbilirubinemili yenidoğanların sonuçlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bir üniversite hastanesi ve bir devlet hastanesinin YYBÜ'lerinde ağır hiperbilirubinemi tanısı ile hastaneye yatırıldıktan sonra kan değişimi yapılan 28 yenidoğanın klinik verilerini topladık.
Bulgular: Başvuru sırasında medyan serum bilirubin düzeyi 31,2 (20,3-36,8) mg/dL olan 28 yenidoğan çalışmaya alındı. En sık kan değişimi nedeni hemolitik sarılık (%67.8) ve bunu uygun beslenememe (%14) takip ediyordu. Hiperbilirubineminin en sık nedeninin Rh uyuşmazlığı olduğu bulundu. Kan değişimi ile ilişkili bildirilen advers olay oranı %71 idi. KD'ye bağlı en sık görülen komplikasyonlar trombositopeni ve anemi idi. İşlem sonrası 4 bebek hayatını kaybetti. Yenidoğanların %39'unda akut bilirubin ensefalopatisi (ABE) tespit edildi. ABE'li yenidoğanlarda serum bilirubin ve bilirubin/albümin oranları yüksek bulundu.
Sonuç: Özellikle hemolitik sarılıkla ilişkili ciddi hiperbilirubinemisi olan yenidoğanların kurtarma ET'sine ihtiyacı olabilir. Bilirubin/albümin oranları yüksek, şiddetli hiperbilirubinemisi olan yenidoğanlar ABE açısından risk altında olduğundan bu olgularda ET düşünülmelidir

Keywords

Yenidoğan, kan değişim transfüzyonu, hiperbilirubinemi, akut bilirubin ensefalopatisi.

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