Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The neuroprotective effects of intravenously or orally administered dpa can make ets. Low albumin levels may be a risk factor for kernicterus liver function tests lft prolonged jaundice. Bilirubin can be removed from the blood most rapidly with exchange transfusion. It is usually harmless but may be due to a serious cause which needs treatment in hospital. To answer this question in general terms, safety and efficacy data see below will be evaluated from clinical trials comparing ebt with either no. Frequency of exchange transfusion in newborns with neonatal. Using hospital discharge data from 2005 to 2011 in new yorks state inpatient database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30day readmission rate after ip, and the number of cases of death, exchange transfusion, and. Is ebt a safe and effective treatment for severe neonatal hyperbilirubinaemia. Neonatal jaundice is one of the most common conditions occurring in newborn infants and is characterized by elevated levels of bilirubin in the blood total serum bilirubin concentration 5 mgdl. This study included overall 306 neonates who underwent et between 2005 and 2012.
Evaluation and treatment of neonatal hyperbilirubinemia karen e. Definition to exchange all or part of an infants blood supply for certain medical conditions. While timely and effective phototherapy and exchange transfusion are well proven. Severe hyperbilirubinaemia requiring exchange transfusion has become less common in recent years.
Exchange transfusion is a potentially lifesaving procedure that is done to counteract the effects of serious jaundice or changes in the blood due to diseases such as sickle cell anemia. Describe the physiologic mechanisms that result in neonatal jaundice. Download as ppt, pdf, txt or read online from scribd. Double volume exchange replacement 85% of circulating red blood cells and reduces bilirubin level by 50%. Neonatal hyperbilirubinemia pediatrics merck manuals. We provide an approach to the use of phototherapy and exchange transfusion in the management of hyperbilirubinemia in preterm infants of download pdf. Exchange transfusion exchange transfusion is indicated for avoiding bilirubin neurotoxicity when other therapeutic modalities have failed or are not sufficient. Quality standard jaundice in newborn babies under 28 days next this guideline covers diagnosing and treating jaundice, which is caused by increased levels of bilirubin in the blood, in newborn babies neonates. A neonate refers to an infant in the first 28 days of life. Exchange transfusion for neonatal hyperbilirubinemia in johannesburg, south africa, from 2006 to 2011. A partial exchange is either increasing or decreasing an. A free powerpoint ppt presentation displayed as a flash slide show on id.
For example, snh refers to neonatal jaundice with serum bilirubin atnear et levels based on. There were 64 patients who underwent 67 exchange transfusions. Neonatal exchange transfusion introduction double volume exchange transfusion is mainly used for the management of hyperbilirubinaemia and haemolytic disease of the newborn, when other methods of treatment such as early and intensive use of phototherapy have been ineffective. The aim of present study was to evaluate the indications and the complications associated with neonatal exchange transfusion et performed for hyperbilirubinemia. A total serum bilirubin level at or above the exchange transfusion level should be considered a medical emergency and intensive phototherapy multiple light should be commenced immediately. Neonatal jaundice is related to breastfeeding in three primary clinical situations. The most common cause of neonatal jaundice is a physiological rise in unconjugated bilirubin, which results from hemolysis of fetal hemoglobin and an immature hepatic metabolism of bilirubin. Exchange transfusion occupies a unique place in the history of neonatal jaundice because it was the first intervention to permit effective control of severe. Phototherapy and exchange blood transfusion are primary treatment modes for significant haemolytic disease of the newborn hdn, to lower serum bilirubin and reduce risk of kernicterus. Neonatal jaundice is yellow colouration of the skin and the sclera of newborn babies due to accumulation of bilirubin. Although neonatal jaundice is a benign condition in most cases, pathologic harmful hyperbilirubinemia can occur, and despite the benefits of. Jaundice is a frequent problem encountered in the first few days after birth in both late preterm and term infants. Muchowski, md, naval hospital camp pendleton family medicine residency program, camp pendleton, california n eonatal jaundice affects up to 84% of term newborns1 and is the most common cause of hospital readmission in the neonatal period.
Maternalfetal blood incompatibility, polycythemia, and severe neonatal jaundice requiring exchange transfusion may potentiate risk of hypoglycemia. Neonatal jaundice national institute for health and care. Exchange transfusion for jaundiced newborns in the united. Exchange transfusion for neonatal hyperbilirubinemia. Phenobarbital is used prophylactically during pregnancy to prevent the occurrences of neonatal. Complications of exchange transfusion in hospitalized neonates in. American academy of pediatrics guidelines for detecting. Neonatal jaundice is very common in the first two weeks of a babys life. Neonatal exchange transfusion sydney local health district. Age h bilirubin mgdl phototherapy exchange transfusion. Exchange blood transfusion an overview sciencedirect topics. In response to the continuing occurrence of cases of kernicterus, the aap has recently issued a revised set of guidelines. The consultant neonatologist on service should be contacted without delay. The guidelines are much more permissive nowadays concerning jaundice at 2 days to 2 weeks of age 10, 11.
Pdf adverse events following blood exchange transfusion. Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. Exchange transfusionrefer to tertiary centre discuss management plan with parents provide parents with information. Severe neonatal hyperbilirubinemia leading to exchange. Neonatal jaundice is more likely to have a serious cause if it is seen in the first. Exchange transfusion is indicated for avoiding bilirubin neurotoxicity when other therapeutic modalities have failed or are not sufficient. However, the new guidelines are far more comprehensive than simply comprising a manual of when to turn on or off the. This topic focuses on recognizing and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinemia. Evaluation and treatment of neonatal hyperbilirubinemia. We included term newborns treated with ip in their first.
Process of blood exchange transfusion for neonatal jaundice by umbilical catheter alshifa hospital nicu palestinegaza. Exchange transfusion is utilized primarily in neonates to decrease bilirubin levels, in order to avoid kernicterus. A total serum bilirubin level at or above the exchange transfusion level should be. Neonatal jaundice refer to online version, destroy printed copies after use page 6 of 40 list of tables. Exchange transfusion for jaundiced newborns in the united statesexchange transfusion is the replacement of blood from newborn infants with elevated bilirubin level in their blood stream with donor blood containing normal bilirubin levels. National academic hospitals consensus guidelines for south african hospitals and primary care. Neonatal jaundice symptoms, diagnosis and treatment.
Neonatal jaundice pdf 525p this note covers the following topics. The demographic characteristics of patients, causes of jaundice and adverse events occurred during or within 1 week. A double volume exchange transfusion is replacingthe babys total blood volume twice, leaving theintravascular amount the same. Neonatal jaundice is the yellowing discoloration of the skin and sclera of a neonate, which is caused by increased levels of bilirubin in the blood. In both birth weight groups, subgroup analysis suggested that, in infants with nonhaemolytic jaundice, phototherapy significantly decreased exchange transfusion compared with no treatment infants 20002499 g. In addition, the procedure may be indicated in infants. Exchange transfusion and intravenous immunoglobulin use in. Phototherapy for neonatal unconjugated hyperbilirubinemia.
Exchange transfusion for neonatal hyperbilirubinemia in. Jaundice in the newborns jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of. Exchange transfusion is commonly used in newborns for immediate treatment of severe hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Blood exchange transfusion bet was introduced in the late 1940s to decrease the mortality attributable to rhesus hemolytic disease of the newborn and to prevent kernicterus in surviving infants. Sirota lea department of neonatology shnaider children s hospital physiologic jaundice healthy infants up to 12mg% in 3rd day. In these infants, it may be possible that change to the caseinhydrolysate might prevent or lessen the additional therapy.
From comparing exchange transfusion treatment over a 39month period prior to the availability of phototherapy to a 39month period incorporating phototherapy in the treatment regimen, the authors conclude that phototherapy 1 acts slowly but constantly to reduce bilirubin. In infants with severe hyperbilirubinemia secondary to t activationinduced hemolysis, exchange. Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia. Neonatal exchange transfusion introduction double volume exchange transfusion is mainly used for the management of hyperbilirubinaemia and haemolytic disease of the newborn, when other methods of treatment such as early and intensive use of phototherapy. A partial exchange is either increasing or decreasingan infants hematocrit, while maintaining a constantblood volume. Exchange transfusion an overview sciencedirect topics. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy. Management of hyperbilirubinemia in the newborn infant 35. Exchange transfusion for neonatal jaundice cochrane. Guideline coverage includes nicu kemh, nicu pch and nets wa.
Revisiting the criteria for exchange transfusion for severe neonatal. Ppt neonatal jaundice powerpoint presentation free to. Neonatal jaundice is caused by increased bilirubin production, decreased bilirubin clearance, or. Pdf phototherapy and exchange transfusion for neonatal. Intensive phototherapy, exchange transfusion, neonatal jaundice. Jaundice approaching exchange transfusion thresholds. Neonatal jaundice and breastfeeding american academy of. An approach to the management of hyperbilirubinemia in the. The role of intensive phototherapy in decreasing the need. Bilisphere 360 is effective in reducing needs for exchange transfusion and duration of phototherapy. Exchange transfusionto do or not to do for neonatal.
Exchange transfusion is a manual procedure in which a patients blood is replaced with donors whole. Neonatal jaundice can be classified as physiological and pathological and can have. We usually do repeat tsb within 4 to 6 hr if initial tsb was in or near the exchange transfusion range. After exchange transfusion with acid citrate dextrose or citrate phosphate dextrose preserved blood 4. The procedure involves slowly removing the persons blood and replacing it with fresh donor blood or plasma. Describe the factors that place an infant at risk for developing severe hyperbilirubinemia.
A double volume exchange transfusion is replacing the babys total blood volume twice, leaving the intravascular amount the same. Efficacy of phototherapy andor exchange transfusions in. History and protocol of neonatal exchange transfusion. Babies with prolonged jaundice visible jaundice persisting for greater than 2 weeks in term. Blood exchange transfusion neonatal jaundice youtube. Neonatal jaundice, exchange transfusion, kernicterus. Repeat tsb in 424 h depending on infants age and tsb level. Since its introduction in the late 1940s 1, exchange transfusion et has been universally.
260 1496 706 1614 422 1218 898 1072 1248 1352 1423 1050 17 423 878 799 236 256 1046 1523 629 264 1519 793 1034 1593 1574 956 1086 252 1393 1055 833 741 613 1335 1288 1440 194 1486 302 568 825 247 222 672 218