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Xiong Z, Liu X, Li X. Efficacy of single-and double-volume exchange transfusion for neonatal hyperbilirubinemia. J Med Biochem 2023; 42:484-491. [PMID: 37790206 PMCID: PMC10543125 DOI: 10.5937/jomb0-42668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 10/05/2023] Open
Abstract
Background To investigate the efficacy and safety of singleand double-volume exchange transfusion for neonatal hyperbilirubinemia (HB) and compare their effects on the internal environment of newborns. Methods The clinical data of 96 HB newborns admitted to and treated in our hospitals from January 2016 to October 2021 were retrospectively analyzed. Then, these newborns were divided into single volume group (80-110 mL/kg, n=48) and double volume group (150-180 mL/kg, n=48) by the exchange volume per unit body mass. The hematological indicators total serum bilirubin (TSB), peripheral blood red blood cell (RBC) count, white blood cell (WBC) count, platelet (PLT) count, serum albumin (ALB), prothrombin time (PT) and activated partial thromboplastin time (APTT), and changes in inner-environment indexes (blood gas, blood glucose, acid-base and electrolyte levels) were compared between the two groups of newborns before treatment and after once treatment. Additionally, the adverse reactions of exchange transfusion in the two groups of newborns were recorded.
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Affiliation(s)
- Zhongzheng Xiong
- Dian Jiang People's Hospital of Chongqing, Department of Medical Laboratory, Chongqing, China
| | - Xianchuan Liu
- Bishan Maternity & Child Hospital of Chongqing, Laboratory Medicine, Chongqing, China
| | - Xiangzhu Li
- Medical University, Bishan Hospital of Chongqing, Department of Blood Transfusion, Chongqing, China
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Diala UM, Usman F, Appiah D, Hassan L, Ogundele T, Abdullahi F, Satrom KM, Bakker CJ, Lee BW, Slusher TM. Global Prevalence of Severe Neonatal Jaundice among Hospital Admissions: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:3738. [PMID: 37297932 PMCID: PMC10253859 DOI: 10.3390/jcm12113738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/12/2023] Open
Abstract
Evidence regarding the adverse burden of severe neonatal jaundice (SNJ) in hospitalized neonates in resource-constrained settings is sparse. We attempted to determine the prevalence of SNJ, described using clinical outcome markers, in all World Health Organization (WHO) regions in the world. Data were sourced from Ovid Medline, Ovid Embase, Cochrane Library, African Journals Online, and Global Index Medicus. Hospital-based studies, including the total number of neonatal admissions with at least one clinical outcome marker of SNJ, defined as acute bilirubin encephalopathy (ABE), exchange blood transfusions (EBT), jaundice-related death, or abnormal brainstem audio-evoked response (aBAER), were independently reviewed for inclusion in this meta-analysis. Of 84 articles, 64 (76.19%) were from low- and lower-middle-income countries (LMICs), and 14.26% of the represented neonates with jaundice in these studies had SNJ. The prevelance of SNJ among all admitted neonates varied across WHO regions, ranging from 0.73 to 3.34%. Among all neonatal admissions, SNJ clinical outcome markers for EBT ranged from 0.74 to 3.81%, with the highest percentage observed in the African and South-East Asian regions; ABE ranged from 0.16 to 2.75%, with the highest percentages observed in the African and Eastern Mediterranean regions; and jaundice-related deaths ranged from 0 to 1.49%, with the highest percentage observed in the African and Eastern Mediterranean regions. Among the cohort of neonates with jaundice, the prevalence of SNJ ranged from 8.31 to 31.49%, with the highest percentage observed in the African region; EBT ranged from 9.76 to 28.97%, with the highest percentages reported for the African region; ABE was highest in the Eastern Mediterranean (22.73%) and African regions (14.51%). Jaundice-related deaths were 13.02%, 7.52%, 2.01% and 0.07%, respectively, in the Eastern Mediterranean, African, South-East Asian and European regions, with none reported in the Americas. aBAER numbers were too small, and the Western Pacific region was represented by only one study, limiting the ability to make regional comparisons. The global burden of SNJ in hospitalized neonates remains high, causing substantial, preventable morbidity and mortality especially in LMICs.
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Affiliation(s)
- Udochukwu M. Diala
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos, University of Jos Lamingo Campus, Jos 930232, Nigeria
| | - Fatima Usman
- Department of Paediatrics, Faculty of Clinical Services, College of Health Sciences, Bayero University, Aminu Kano Teaching Hospital Campus, Kano 700006, Nigeria
| | - Duke Appiah
- Department of Public Health, School of Population and Public Health, Faculty of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Laila Hassan
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Tolulope Ogundele
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife 220005, Nigeria
| | - Fatima Abdullahi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Main Campus, Zaria 810211, Nigeria
| | - Katherine M. Satrom
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
| | - Caitlin J. Bakker
- Dr. John Archer Library and Archives, University of Regina, Regina, SK S4S 0A2, Canada
| | - Burton W. Lee
- National Institute of Health, Bethesda, MD 20892, USA
| | - Tina M. Slusher
- Department of Pediatrics, Faculty of Medical School, School of Medicine, University of Minnesota, University of Minnesota Twin Cities Campus, Minneapolis, MN 55455, USA
- Hennepin Healthcare, Minneapolis, MN 55415, USA
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Exchange blood transfusion for hyperbilirubinaemia: Neonatal characteristics and short-term outcomes. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i4.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. Factors that have been associated with severe hyperbilirubinaemia requiring exchange blood transfusion (EBT) are early discharge, late preterm birth and haemolytic disease. Early discharge is a common practice in neonatal care, so it is important to identify and audit neonates who received EBT, in order to identify modifiable factors.
Objectives. To describe the characteristics and outcomes of infants requiring EBT.
Methods. We reviewed records of infants admitted with severe jaundice requiring EBT from January 2009 to December 2013. Descriptive analysis of characteristics, clinical presentation, laboratory findings and outcome at discharge was performed.
Results. A total of 150 neonates received EBT (30 per year), and 101 were reviewed. Of these, 34 (33.7%) were inpatients and 67 (66.3%) were new admissions (2.34/1 000 new admissions). The majority of neonates requiring EBT were born vaginally (86.1%), were late preterm births (20.8%) and were exclusively breastfed (82.2%). The median postnatal age at presentation was 5 days. Clinical signs suggestive of acute bilirubin encephalopathy were present in 24.8% of cases. Among mother-infant pairs with known blood groups, 9.3% and 70.4% had rhesus (Rh) and ABO incompatibility, respectively. A Coombs test was positive in 62.5% of those with Rh incompatibility compared with 31.7% of those with ABO incompatibility. A total of 6 patients (5.9%) died, all within 7 days of EBT, but none during EBT.
Conclusion. The majority of neonates requiring EBT presented post discharge after birth and had been born vaginally at term, suggesting early discharge after delivery. More than two-thirds of cases were related to ABO incompatibility. Screening for jaundice before discharge must be prioritised, especially for infants born to mothers who are Rh negative or ABO blood group O.
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Zhang R, Kang W, Zhang X, Shi L, Li R, Zhao Y, Zhang J, Yuan X, Liu S, Li W, Xu F, Cheng X, Zhu C. Outcome Analysis of Severe Hyperbilirubinemia in Neonates Undergoing Exchange Transfusion. Neuropediatrics 2022; 53:257-264. [PMID: 35038754 DOI: 10.1055/s-0041-1742156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Ruili Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenqing Kang
- Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Lina Shi
- Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Rui Li
- Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yanmei Zhao
- Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jing Zhang
- Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiao Yuan
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shasha Liu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenhua Li
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Falin Xu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiuyong Cheng
- Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons. J Clin Med 2022; 11:jcm11051240. [PMID: 35268331 PMCID: PMC8910835 DOI: 10.3390/jcm11051240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Neonatal sepsis remains a leading cause of morbidity and mortality worldwide. It is widely considered that exchange transfusion (ET) as an adjunctive treatment for neonatal sepsis has the ability to reduce mortality. This review summarizes the current knowledge regarding the efficacy of ET for neonatal sepsis. In neonatal sepsis, immune responses such as proinflammatory and anti-inflammatory cytokines play an important role in pathogenesis and can lead to septic shock, multiple organ failure, and death. Between the 1970s and 1990s several authors reported that ET was effective in the treatment of neonatal sepsis with sclerema. ET removes bacterial toxins and inflammatory cytokines from the blood by replacing it with fresh and immunologically abundant blood, thereby leading to improvement in tissue perfusion and oxygenation. Moreover, ET with fresh whole blood increases neutrophil count and immunoglobulin levels as well as enhancing neutrophil function. However, there is a lack of clear evidence for the clinical efficacy of ET. In addition, adverse events associated with ET have been reported. Although most complications are transient, ET can lead to life-threatening complications. Therefore, ET can be considered a last resort treatment to rescue neonates with severe sepsis with sclerema and disseminated intravascular coagulation.
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Ramachandran RM, Srinivasan R. Clinical Profile and Outcome Following Exchange Transfusion for Neonatal Jaundice in a Tertiary Care Centre. J Trop Pediatr 2022; 68:6515780. [PMID: 35084035 DOI: 10.1093/tropej/fmac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Phototherapy has reduced the need for exchange transfusion (ET) to manage jaundiced neonates. Hence there are concerns about increased risk of complication due to lack of opportunity to sustain skills in performing ET. We studied the complications and treatment outcomes of neonates treated for jaundice with ET. METHODOLOGY A retrospective observational study was conducted from June 2013 to June 2020 in a tertiary care hospital in India. All neonates treated with ET for jaundice were included. RESULTS Twenty-eight neonates underwent 31 ET during the study period. Their mean gestational age and birth weight were 37 weeks and 3200 g, respectively. Predisposing factor for jaundice observed were Coomb's positive status (11), hepatosplenomegaly suggesting hemolysis (3), cephalhematoma (2) and birth asphyxia (1). Abnormal neurological status before ET was seen in seven neonates. Adverse clinical events that happened during or within 8 h after ET were desaturation (4), tachycardia (3), tachypnea (2), bradycardia (2), shock (2) and temperature instability (2). One neonate developed acute kidney injury after ET and required peritoneal dialysis. Abnormal lab parameters observed during or within 8 h after ET were hypocalcemia (20), anemia (8), hypokalemia (7), hypernatremia (3), thrombocytopenia (3) and hyperkalemia (2). Post ET sepsis was seen in five neonates: two had only blood culture positive sepsis, two had bone and joint infection and one had liver abscess. CONCLUSION The neonates undergoing ET are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed.
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Affiliation(s)
- Rajashree M Ramachandran
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
| | - Ramesh Srinivasan
- Department of Pediatrics, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu 641004, India
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Lu WN, Yang XY, Ning SY, Chen ZG, Pan SN. 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. Pediatr Neonatol 2021; 62:312-320. [PMID: 33678593 DOI: 10.1016/j.pedneo.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
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, PaO2, PaCO2, 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 ETs, including background activities, SWC, and seizures. However, there were significant differences in suppressions on background activities, while there were no significant statistical differences in SWC or seizures between the 2 groups. CONCLUSION Fully automated simultaneous peripheral arteriovenous ET is safe and efficient without significant influence on the disorder of the internal environment and electroencephalographic activities after ET in neonates. However, background activities are more significantly depressed in infants of bilirubin encephalopathy than infants of non-encephalopathy during ET.
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Affiliation(s)
- Wei-Neng Lu
- Neonatology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China; Neonatology Department, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiao-Yuan Yang
- Pediatric Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shu-Yao Ning
- EEG Department, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhuang-Gui Chen
- Pediatric Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Si-Nian Pan
- Pediatric Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr 2021; 56:121-126. [PMID: 34286320 DOI: 10.14744/turkpediatriars.2020.65983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
Objective The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born ≥35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9±9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breastfeeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.
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Pan J, Zhan C, Yuan T, Chen X, Ni Y, Shen Y, Chen W, Wu T, Yu H. Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study. J Perinatol 2021; 41:1397-1402. [PMID: 33589732 PMCID: PMC8225508 DOI: 10.1038/s41372-021-00963-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of intravenous immunoglobulin G (IVIG) in infants with ABO hemolytic disease of the newborn (HDN). METHODS Infants with moderate-to-severe ABO HDN during early neonatal period (<7 days) at our hospital in 2017 were included in this retrospective study. Patients treated with IVIG and phototherapy were classified as the IVIG group, and those who only received phototherapy were classified as the phototherapy only group. RESULTS Forty-six patients were classified into the IVIG group and 68 other patients were classified into the phototherapy only group. There was no significant difference in duration of phototherapy, hospitalization periods, needs for exchange transfusion, transfusions, and incidence of bilirubin-induced neurological sequelae between these two groups (P = 0.20, 0.27, 0.65, 0.47, 0.78, respectively). CONCLUSION It seems unnecessary to expose neonates to IVIG in moderate-to-severe ABO HDN when the available data show no appreciable benefits.
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Affiliation(s)
- Jiarong Pan
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Canyang Zhan
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Tianming Yuan
- Department of Neonatology, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People's Republic of China.
| | - Xiangxiang Chen
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Yanyan Ni
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Ying Shen
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Weiwei Chen
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Tai Wu
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
| | - Huimin Yu
- grid.13402.340000 0004 1759 700XDepartment of Neonatology, the Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang People’s Republic of China
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Shakur A, Garba N, Ahmadu I, Apollos D, Wada A, Abdullahi S, Mohammed A, Asani M, Aliyu I. Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry. JOURNAL OF ACUTE DISEASE 2021. [DOI: 10.4103/2221-6189.316675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Duan L, Gan S, Hu H. A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan. J Matern Fetal Neonatal Med 2020; 34:466-472. [PMID: 33225794 DOI: 10.1080/14767058.2020.1844659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the clinical experience in application of exchange transfusion therapy (ETT) in the treatment of severe neonatal hyperbilirubinemia. METHODS The clinical data and examination results of severe neonatal hyperbilirubinemia full-term cases treated by ETT were analyzed retrospectively, the etiology and risk factors of severe neonatal hyperbilirubinemia were statistically analyzed, and the statistical characteristics of the children in each etiological group and the incidence of adverse events of ETT were analyzed. RESULTS The age of jaundice, peak total bilirubin after phototherapy and ETT in 123 full-term infants were 2.0 (1.0, 3.0) days, 4.0 (2.0, 7.0) days and 4.0 (2.0, 7.0) days, respectively, of which 68 were male and 55 were female. The main pathogeny of severe neonatal hyperbilirubinemia was blood group incompatibility hemolytic disease of newborn (HDN). Age of ETT, total bilirubin after ETT, gender and BAEP results were different between ABE and non-ABE infants. Weight loss can be used as a predictor of hospitalization length. The major adverse events related to ETT were hypocalcemia, hypomagnesemia, hyponatremia and thrombocytopenia. CONCLUSIONS ETT can rapidly reduce the level of total bilirubin to prevent ABE and play an important role in the treatment of neonatal hyperbilirubinemia, but the whole process of ETT needs to be closely monitored.
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Affiliation(s)
- Ling Duan
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Gan
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbing Hu
- Department of Blood Transfusion, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L, Kpa M, McMannen T, Reyes I, Zimmerman KO, Clark RH, Greenberg RG. Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol 2020; 40:1506-1512. [PMID: 32152492 PMCID: PMC8021453 DOI: 10.1038/s41372-020-0642-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality. STUDY DESIGN We conducted a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilirubinemia who underwent ET within 30 days of birth from 1997 to 2016. We examined clinical characteristics and adverse events after ET. We used multivariable logistic regression to examine the association between clinical risk factors and death. RESULT A total of 1252 infants were included; 4% died within 7 days of ET and 6% died before discharge. Compared with infants ≥37 weeks of GA, infants ≤29 weeks of GA had greater odds of death (adjusted odds ratio [95% confidence interval] = 20.08 [7.32, 55.07]). CONCLUSIONS Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.
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Affiliation(s)
- Mattie F Wolf
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Julie Childers
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Keyaria D Gray
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Caroline Chivily
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mike Glenn
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Laila Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mini Kpa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Taylor McMannen
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Isaias Reyes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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13
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Authors' response to thrombocytopenia following exchange transfusion in neonates. J Perinatol 2020; 40:1119. [PMID: 32398737 DOI: 10.1038/s41372-020-0687-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/16/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
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14
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Thrombocytopenia following exchange transfusion in neonates. J Perinatol 2020; 40:1120. [PMID: 32398736 DOI: 10.1038/s41372-020-0683-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/03/2020] [Accepted: 04/25/2020] [Indexed: 11/08/2022]
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Abstract
ABO incompatibility (ABOi), the most common cause of hemolytic disease of the newborn (HDN), is nearly always mild and treatable with phototherapy. Reports of ABOi HDN requiring neonatal exchange transfusion are extremely rare since the inception of modern guidelines. Here, a case of ABOi HDN clearly met criteria for exchange transfusion. An O-positive African American mother delivered a B-positive neonate that quickly developed hyperbilirubinemia. The neonatal DAT was positive from anti-B and anti-A,B, and maternal IgG titer was 1024. Double volume exchange transfusion resulted in a favorable outcome. Given early discharge of newborns, further understanding of factors predicting severe disease is needed.
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Sajedi F, Fatollahierad S. Effect of Purgative Manna on Neonatal Hyperbilirubinemia: A Systematic Review and Meta-analysis. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2019; 18:1020-1031. [PMID: 31531082 PMCID: PMC6706735 DOI: 10.22037/ijpr.2019.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim of this systematic review was to evaluate the effect of purgative manna on the unconjugated hyperbilirubinemia in neonates. Pubmed, Scopus, Chochrane library, Iranmedex and Google scholar were last searched in February 2017. Randomized controlled trials that evaluated the effect of purgative manna on the treatment of neonatal hyperbilirubinemia were included in the review. For meta-analysis, weighted mean difference (WMD) with 95% confidence interval (CI) was used. The outcomes of interests were serum bilirubin levels and length of hospital stay in neonates with jaundice. Seven randomized controlled trials with 812 neonates were eligible to be included in this systematic review. The meta-analysis included six of seven controlled trials. Bilirubin levels were significantly lower at 12 h (WMD: -1.48, 95% CI: -2.31 to -0.65), 24 h (WMD: -2.47, 95% CI: -3.22 to -1.71), 36 h (WMD: -2.83, 95% CI: -4.87 to -0.80), 48 h (WMD: -1.49, 95% CI: -2.36 to -0.63) and 72 h (WMD: -0.68, 95% CI: -1.28 to -0.08) following intervention in purgative manna group. Length of hospital stay was also decreased in purgative manna group (WMD: -0.93, 95% CI: -1.35 to -0.50). Finally, purgative manna administration decreased serum bilirubin level and length of hospital stay in neonates with unconjugated hyperbilirubinemia. More studies are needed to evaluate the efficacy, dosage, and side effects of purgative manna.
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Affiliation(s)
- Firoozeh Sajedi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shiva Fatollahierad
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Al-Lawama M, Al-Rimawi E, Al-Shibi R, Badran E. Adoption of the American Academy of Pediatrics' neonatal hyperbilirubinemia guidelines and its effect on blood exchange transfusion rate in a tertiary care center in Amman, Jordan. J Blood Med 2018; 9:61-66. [PMID: 29713209 PMCID: PMC5908209 DOI: 10.2147/jbm.s162191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Severe neonatal hyperbilirubinemia can cause mortality and serious morbidities. When phototherapy fails, neonates with severe hyperbilirubinemia should undergo double volume blood exchange transfusion (BET). As this procedure carries a significant risk of mortality and morbidity, adopting guidelines for the treatment of neonatal hyperbilirubinemia is critical to avoid hyperbilirubinemia toxicity and also the complication of an unindicated procedure. METHODS This study investigated the causes, complications, and trend of BET rate in our unit over a 13-year period. The medical charts and laboratory databases of all infants who underwent BET in Jordan University Hospital between 2003 and 2015 were retrospectively reviewed. RESULTS The rate of exchange cases decreased significantly after adopting the guidelines of American Academy of Pediatrics (P<0.0001). Most neonates were term newborns (69%). Average birth weight was 2,800 g. The most common causes of exchange transfusion were non-hemolytic conditions. Late prematurity alone accounted for 20% of the cases. Thrombocytopenia was the most commonly encountered complication (33%). Chronic neurological complications were seen in 12% of those who were followed for >12 months of age. CONCLUSIONS This study showed a clear decline in the rate of BET after implementing the guidelines of American Academy of Pediatrics. In addition to improving the strategies for the identification and follow-up of at-risk newborns, we should intensify our efforts to prevent the progression of neonatal hyperbilirubinemia to the exchange level by enhancing parents' awareness of this potentially harmful neonatal condition.
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Affiliation(s)
- Manar Al-Lawama
- Department of Pediatrics, The University of Jordan, School of Medicine, Amman, Jordan
| | - Eman Al-Rimawi
- Department of Pediatrics, The University of Jordan, School of Medicine, Amman, Jordan
| | - Rawan Al-Shibi
- Department of Pediatrics, The University of Jordan, School of Medicine, Amman, Jordan
| | - Eman Badran
- Department of Pediatrics, The University of Jordan, School of Medicine, Amman, Jordan
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Zhang M, Wang L, Wang Y, Tang J. The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2018; 32:3109-3114. [PMID: 29631455 DOI: 10.1080/14767058.2018.1455183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia. Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model. Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4 d (mean difference (MD) = -2.31; 95% CI = -2.92 to -1.70; p < .00001) and transcutaneous bilirubin level within 4 d for neonatal hyperbilirubinemia (MD = -1.97; 95% CI = -2.55 to -1.39; p < .00001), but results no remarkable impact on serum bilirubin level on 2 d (MD = -0.82; 95% CI = -2.16-0.52; p = .23), transcutaneous bilirubin level on 2 d (MD = -0.17; 95% CI = -1.34 to 1.00; p = .77), frequency of defecation daily on 2 d (MD = 0.57; 95% CI = -0.03 to 1.16; p = .06), and frequency of defecation daily within 4 d (MD = 0.83; 95% CI = -0.11 to 1.76; p = .08). Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4 d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2 d, frequency of defecation daily on 2 and 4 d for neonatal hyperbilirubinemia.
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Affiliation(s)
- Min Zhang
- a Department of Pediatrics , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Lili Wang
- a Department of Pediatrics , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Yang Wang
- a Department of Pediatrics , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
| | - Jiulai Tang
- a Department of Pediatrics , The First Affiliated Hospital of Anhui Medical University , Hefei , Anhui , China
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Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F, Tunc G, Atasay B, Gultekin ND, Arsan S, Koc E. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One 2018; 13:e0193108. [PMID: 29474382 PMCID: PMC5825038 DOI: 10.1371/journal.pone.0193108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background Neonatal jaundice (NNJ) is common, but few root cause analyses based on national quality registries have been performed. An online registry was established to estimate the incidence of NNJ in Turkey and to facilitate a root cause analysis of NNJ and its complications. Methods A multicenter prospective study was conducted on otherwise healthy newborns born at ≥35 weeks of gestation and hospitalized for only NNJ in 50 collaborator neonatal intensive care units across Turkey over a 1-year period. Patients were analyzed for their demographic and clinical characteristics, treatment options, and complications. Results Of the 5,620 patients enrolled, 361 (6.4%) had a bilirubin level ≥25 mg/dL on admission and 13 (0.23%) developed acute bilirubin encephalopathy. The leading cause of hospital admission was hemolytic jaundice, followed by dehydration related to a lack of proper feeding. Although all infants received phototherapy, 302 infants (5.4%) received intravenous immunoglobulin in addition to phototherapy and 132 (2.3%) required exchange transfusion. The infants who received exchange transfusion were more likely to experience hemolytic causes (60.6% vs. 28.1%) and a longer duration of phototherapy (58.5 ± 31.7 vs. 29.4 ± 18.8 h) compared to infants who were not transfused (p < 0.001). The incidence of short-term complications among discharged patients during follow-up was 8.5%; rehospitalization was the most frequent (58%), followed by jaundice for more than 2 weeks (39%), neurological abnormality (0.35%), and hearing loss (0.2%). Conclusions Severe NNJ and bilirubin encephalopathy are still problems in Turkey. Means of identifying at-risk newborns before discharge during routine postnatal care, such as bilirubin monitoring, blood group analysis, and lactation consultations, would reduce the frequency of short- and long-term complications of severe NNJ.
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Affiliation(s)
- Omer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
- * E-mail:
| | - Ozgur Olukman
- Department of Pediatrics, Division of Neonatology, Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Dilek Ulubas
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Gokhan Buyukkale
- Department of Pediatrics, Division of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Fatma Narter
- Department of Neonatology, Kartal Lutfi Kirdar Education and Training Hospital, Istanbul, Turkey
| | - Gaffari Tunc
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nazli Dilay Gultekin
- Department of Pediatrics, Division of Neonatology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University School of Medicine, Ankara, Turkey
| | - Esin Koc
- Department of Pediatrics, Division of Neonatology, Gazi University School of Medicine, Ankara, Turkey
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Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: a systematic review of current evidence. J Matern Fetal Neonatal Med 2016; 30:1953-1962. [DOI: 10.1080/14767058.2016.1234600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Deepak Sharma
- Department of Pediatrics, Pt B.D Sharma, PGIMS, Rohtak, Haryana, India,
| | - Nazanin Farahbakhsh
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Pradeep Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, and
| | - Sweta Shastri
- Department of Pathology, N.K.P Salve Medical College, Nagpur, Maharashtra, India
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21
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Aydin M, Deveci U, Orman A, Taskin E, Kilic M. Audit of Pediatric Transfusion Practices in a Tertiary Care Hospital: Correspondence. Indian J Pediatr 2016; 83:1059-60. [PMID: 27039914 DOI: 10.1007/s12098-016-2083-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Mustafa Aydin
- Department of Pediatrics-Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey.
| | - Ugur Deveci
- Department of Pediatrics-Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey
| | - Aysen Orman
- Department of Pediatrics-Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey
| | - Erdal Taskin
- Department of Pediatrics-Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey
| | - Mehmet Kilic
- Department of Pediatrics-Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey
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Abstract
OBJECTIVES To identify the predictors of repeat exchange transfusion among infants with severe hyperbilirubinemia. DESIGN Retrospective cross-sectional study. SETTING A referral children's hospital in inner-city Lagos, Nigeria. PATIENTS Infants who received exchange transfusion for severe hyperbilirubinemia from January 2012 to December 2014. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS The predictors of repeat exchange transfusion were identified among all infants who had at least one exchange transfusion using multivariable logistic regression. A total of 352 infants with mean peak total serum bilirubin of 26.32 ± 7.96 mg/dL received exchange transfusion; of these, 49 (13.9%) with mean peak total serum bilirubin of 32.85 ± 10.54 mg/dL had repeat exchange transfusion. More than two thirds of infants who received exchange transfusion and repeat exchange transfusion were male, and at least one third had ABO incompatibility. No infant had more than two exchange transfusions. The mean age of admission was approximately 5 days (range, 1-14 d). Peak total serum bilirubin greater than or equal to 30 mg/dL (odds ratio, 2.88; 95% CI, 1.46-5.70) and acute bilirubin encephalopathy (odds ratio, 2.37; 95% CI, 1.18-4.77) were predictive of repeat exchange transfusion. CONCLUSIONS Acute bilirubin encephalopathy and excessive total serum bilirubin levels at least 30 mg/dL are predictive of repeat exchange transfusion. A risk assessment framework that combines total serum bilirubin levels, acute bilirubin encephalopathy status, and risk factors of neurotoxicity should be considered for the timely detection and monitoring of infants at risk of repeat exchange transfusion.
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Cherepnalkovski AP, Krzelj V, Zafirovska-Ivanovska B, Gruev T, Markic J, Aluloska N, Zdraveska N, Piperkovska K. Evaluation of Neonatal Hemolytic Jaundice: Clinical and Laboratory Parameters. Open Access Maced J Med Sci 2015; 3:694-8. [PMID: 27275310 PMCID: PMC4877910 DOI: 10.3889/oamjms.2015.129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 11/10/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND: Neonatal jaundice that occurs in ABO or Rhesus issoimunisation has been recognized as one of the major risk factors for development of severe hyperbilirubinemia and bilirubin neurotoxicity. AIM: Aim of our study was to investigate clinical and laboratory parameters associated with hemolytic jaundice due to Rh and ABO incompatibility and compare results with the group of unspecific jaundice. MATERIAL AND METHODS: One hundred sixty seven (167) neonatal hyperbilirubinemia cases were included in the study, 24.6% of which presented with ABO/Rhesus type hemolytic jaundice, and the rest with unspecific jaundice. Evaluation included: blood count, reticulocites, serum bilirubin, aminotransferases, blood grouping, and Coombs test, also the day of bilirubin peak, duration of the hyperbilirubinemia, and additional bilirubin measurements. RESULTS: We showed significantly lower mean values of hemoglobin, erythrocytes and hematocrit and significantly higher values of reticulocytes in the group of ABO/Rh incompatibility compared to the group of jaundice of unspecific etiology; also an earlier presentation and a higher-grade jaundice in this group. CONCLUSIONS: The laboratory profile in ABO/Rh isoimmunisation cases depicts hemolytic mechanism of jaundice. These cases carry a significant risk for early and severe hyperbilirubinemia and are eligible for neurodevelopmental follow-up. Hematological parameters and blood grouping are simple diagnostic methods that assist the etiological diagnosis of neonatal hyperbilirubinemia.
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Affiliation(s)
- Anet Papazovska Cherepnalkovski
- University Pediatric Clinic - Neonatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vjekoslav Krzelj
- University Hospital Split and School of Medicine, University of Split, Split, Croatia
| | - Beti Zafirovska-Ivanovska
- Institute of Epidemiology and Biostatistics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Todor Gruev
- Institute for Clinical Biochemistry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Josko Markic
- University Hospital Split and School of Medicine, University of Split, Split, Croatia
| | - Natasa Aluloska
- University Pediatric Clinic - Neonatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Nikolina Zdraveska
- University Pediatric Clinic - Neonatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Katica Piperkovska
- University Pediatric Clinic - Neonatology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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