Exchange transfusion in neonatal hyperbilirubinemia: A single Centre experience from Northern India

Kakkar, Brinda; Agrawal, Soma; Chowdhry, Mohit; Muthukumaravel, P.J.; Makroo, Raj Nath; Thakur, Uday Kumar

doi:10.1016/j.transci.2019.09.008

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…Mean cord Hb was 11.82 ± 3.07, and mean post-exchange Hb was 12.97 ± 2.57. According to the study by Kakkar, 13 a statistically significant reduction in serum bilirubin levels was noted post-procedure ( p <0.001) with an overall reduction in bilirubin levels/procedure being 46%. Similar expectant efficacy was published by other authors.…”

Section: Discussionmentioning

confidence: 95%

“…Most of the relevant published studies are retrospective; few reported trends of exchange transfusion in their study place, 1 , 11 , 12 while some authors focused on incidence, indication of the exchange transfusion, and adverse events related to exchange transfusion. 2 , 4 , 5 , 13 , 14 Some recent prospective studies in the South Asia region mainly focused on adverse events following exchange transfusion. 15 , 16 According to a retrospective hospital-based study in Bangladesh, ABO incompatibility was the commonest identified cause of exchange transfusion and adverse events remain common after exchange transfusion.…”

Section: Introductionmentioning

confidence: 99%

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Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

Dey¹,

Jahan²,

Jahan³

et al. 2021

Euroasian Journal of Hepato-Gastroenterology

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A bstract Background Exchange transfusion in newborns is recommended as emergency management of hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Aim This study aimed to determine the frequency and document common side effects of exchange transfusion and outcomes of newborns requiring exchange transfusion. Materials and methods This prospective study was done in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2016 to December 2019. Information was obtained regarding maternal details, newborn demographics, and clinical status. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, Coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, hemoglobin, random blood sugar, serum electrolyte, and calcium were done. G6PD level was done wherever suspected. Frequency, maternal and neonatal factors, indications, and outcomes were analyzed. Results Among 839 admitted cases of unconjugated hyperbilirubinemia, 41 patients (4.9%) required exchange transfusion. Most of the babies were inborn (90.2%). Ninety-five percent of mothers received regular antenatal care; among them, 76.3% had bad obstetric history. Only 36.6% of mothers received anti-D in previous pregnancy. None had sonographic findings of hydrops. The commonest indication was Rh incompatibility (80.5%). Coombs test was positive in 58.5% of cases. Mean pre-exchange TSB was 9.44 ± 6.4, and post-exchange TSB was 4.41 ± 2.59. The commonest adverse events noted were hyperglycemia (51.2%), sepsis (19.5%), anemia requiring top-up transfusion (17.1%), and hypocalcemia (14.6%). There were no catheter-related complications. Bilirubin encephalopathy was present in 4.9% of cases. There was one mortality but not due to the procedure. Conclusion Exchange transfusion was required among 4.9% of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effects were hyperglycemia and sepsis. The commonest indication was Rh incompatibility (80.5%). Overall outcome after exchange transfusion was favorable. How to cite this article Dey SK, Jahan S, Jahan I, et al. Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study. Euroasian J Hepato-Gastroenterol 2021;11(1):21–26.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

Dey¹,

Jahan²,

Jahan³

et al. 2021

Euroasian Journal of Hepato-Gastroenterology

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“…14 In our study, a statistically significant reduction in total bilirubin and indirect bilirubin levels were noted post-procedure (p < 0.001) with the overall removal rate of total bilirubin and indirect bilirubin being 54.20% and 55.68%, respectively, which is similar to the findings published by other authors. 15,16 During the ET procedure, it is important to maintain the homeostasis of the patients. Old data showed that mortality within 6 h of ET in infants without hemolysis was three or four per 1000 infants.…”

Section: Discussionmentioning

confidence: 99%

Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia

Yang

Ning

et al. 2021

Pediatrics & Neonatology

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Background: The acute changes in brain function in newborn infants undergoing ET remain unclear. This study aimed to determine whether fully automated simultaneous peripheral arteriovenous ET would influence the brain function. Methods: A retrospective analysis was conducted on the clinical data of 39 neonates with hyperbilirubinemia who received ET. Seventeen patients were in the encephalopathy group, and the other 22 patients were in the non-encephalopathy group. Changes in amplitude-integrated electroencephalogram (aEEG) during ETs were analyzed, including background activities, sleep-wake cycling (SWC), and seizures. Before and after the ET, routine blood test parameters, electrolytes, blood glucose, and blood gas parameters were measured. Results: After ETs, there were no significant changes in the levels of pH, PaO 2 , PaCO 2 , lactate, and red blood cells, while the levels of total bilirubin, indirect bilirubin, blood potassium, blood sodium, serum calcium, while blood cells, and platelets were significantly lower and the level of blood glucose was significantly higher compared to those before therapy. There was no significant difference in the changes of electroencephalographic activities during

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“…As is well reported in the literature, ABORh isoimmunisation is the most common cause of NNH. [5][6][7] Consequently, increased awareness about the significance of simple interventions and provision of training to the peripheral health workers (both in government and private health units) is essential. Further, as is also well-known, 16,17 pathological weight loss is associated with severe hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have evaluated the clinical profile and outcome in neonates undergoing EBT. [5][6][7] However, data regarding the identification of possible interventions at peripheral hospitals to help in the early diagnosis of NNH and subsequent decrease in the incidence of EBT are scantily available. The present study examines the clinical profile of referred neonates who underwent EBT and identifies the possible interventions at peripheral hospitals to decrease the severity of NNH.…”

Section: Introductionmentioning

confidence: 99%

Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

2020

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Our descriptive study examines the clinical profile of referred neonates who underwent exchange blood transfusion (EBT) and identifies possible interventions at peripheral hospitals to decrease their severe hyperbilirubinemia. Among the 38 neonates enrolled, the following were identified as potential clinical gaps in management: early discharge within 24 h of birth (57%); non-availability of ABORh blood grouping (43%); lack of anti-D immunoprophylaxis (75%); pathological weight loss because of inadequate breastfeeding (42%); and low usage of phototherapy. Because of late recognition, the mean age at admission was 5.4 ± 3.3 days, levels of total serum bilirubin (TSB) were 516.4 ± 123.1 µmol/L, and acute bilirubin encephalopathy (ABE) was seen in 45% of neonates. Rh iso-immunisation (39.5%), ABO iso-immunisation (21%) and sepsis (8%) were major risk factors for severe hyperbilirubinaemia. Quality prenatal screening identifying at-risk newborns, preventing early discharge after birth, a bilirubin nomogram risk assignment before discharge and assuring early recognition of hyperbiliubinaemia by parents may well minimise the incidence of EBT.

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Exchange transfusion in neonatal hyperbilirubinemia: A single Centre experience from Northern India

Cited by 8 publications

References 14 publications

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia

Exchange blood transfusion in neonates with severe hyperbilirubinemia in a lower-middle-income country: can we minimise the incidence?

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