Outcome Analysis of Severe Hyperbilirubinemia in Neonates Undergoing Exchange Transfusion

Abstract

Objective Severe neonatal hyperbilirubinemia can cause neurological disability or mortality if not effectively managed. Exchange transfusion (ET) is an efficient treatment to prevent bilirubin neurotoxicity. The purpose of this study was to evaluate outcomes in severe neonatal hyperbilirubinemia with ET and to identify the potential risk factors for poor outcomes. Methods Newborns of ≥28 weeks of gestational age with severe hyperbilirubinemia who underwent ET from January 2015 to August 2019 were included. Demographic data were recorded and analyzed according to follow-up outcomes at 12 months of corrected age. Poor outcomes were defined as death due to bilirubin encephalopathy or survival with at least one of the following complications: cerebral palsy, psychomotor retardation (psychomotor developmental index < 70), mental retardation (mental developmental index < 70), or hearing impairment. Results A total of 524 infants were eligible for recruitment to the study, and 62 infants were lost to follow-up. The outcome data from 462 infants were used for grouping analysis, of which 398 cases (86.1%) had normal outcomes and 64 cases (13.9%) suffered poor outcomes. Bivariate logistic regression analysis showed that peak total serum bilirubin (TSB) (odds ratio [OR] = 1.011, 95% confidence interval [CI] = 1.008–1.015, p = 0.000) and sepsis (OR = 4.352, 95% CI = 2.013–9.409, p < 0.001) were associated with poor outcomes of hyperbilirubinemia. Receiver operator characteristic curve analysis showed that peak TSB ≥452.9 µmol/L could predict poor outcomes of severe hyperbilirubinemia. Conclusion Peak TSB and sepsis were associated with poor outcomes in infants with severe hyperbilirubinemia, and peak TSB ≥452.9 µmol/L could predict poor outcomes.

Fototerapia y Exanguinotransfusión como Tratamiento en Neonatos con Hiperbilirrubinemia. Revisión sistemática

“…Aunque esta práctica ha sido efectiva para reducir rápidamente los niveles de bilirrubina en situaciones graves y prevenir el desarrollo de kernicterus, su utilización ha disminuido en la actualidad debido a su mayor complejidad y la asociación con complicaciones significativas. Según Zhang et al, (2022) la aplicación de esta intervención como tratamiento reduce de forma casi inmediata los niveles de bilirrubina.…”

Treatment Outcome of Jaundice and Its Associated Factors Among Neonates Treated in Neonatal Intensive Care Unit of Comprehensive and Specialized Hospitals of Southern Nations Nationalities and Peoples Region, Ethiopia 2022

“…This finding was consistent with studies conducted in China. 50 The possible reason might be due to the fact that unconjugated bilirubin is neurotoxic at a high level that can lead to ABE and eventually death. 51 …”