DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20193748

Clinical profiles and outcomes of neonates with neonatal hyperbilirubinemia and treated with double volume exchange transfusion: a retrospective study

Janaki Ballav Pradhan, C. N. Kamalarathnam

Abstract


Background: Double volume exchange transfusion (DVET) for severe unconjugated hyperbilirubinemia has become less common events now days in pediatric practices. But kernicterus is still common in low income country like India. The aim of the study was to determine the clinical profile and outcome in neonates who were treated with DVET.

Methods: This was a retrospective study in neonate’s ≥34 weeks of gestation that were treated with DVET for severe neonatal hyperbilirubinemia over a period of four years.

Results: In our study, 37 neonates underwent DVET. Male neonates (62.13%) and normal vaginal delivery (NVD) (70.2%) are common. ABO Isoimmunisation was commonest cause (56.75%) of exchange transfusion.  The mean TSBR at pre exchange and Post Exchange were 27.39 ± 5.99mg/dl and 15.16 ± 4.00mg/dl (p<0.05). Ten neonates (27%) among 37 neonates required twice DVET.Thrombocytopenia14 (37.83%); Seizure 5(13.5%) and Hypocalcaemia 3(8.1%) were common complication noted among total 17 (45.94%) neonates. BIND occurred in 15 neonates (40.5%) at the time of admission and seven (18.9%) neonates had persistent neurological abnormality at discharge. Neonate with BIND had early onset of jaundice (44.13±15.37 hours vs. 61.22±28.23hrs, p<0.05), with  higher  pre exchange TSBR value(28.96 ±8.5mg/dl vs. 26.22±3.17mg/dl). Neonates admitted with BIND had higher percentage of persistent encephalopathy (40% vs. 4.5%,p<0.05), abnormal tone (33.3% vs. 4.5%,p<0.05), abnormal feeding (33.3% vs. 4.5%,p<0.05) and abnormal posture (26.6% vs. 0%,p<0.05)  at discharge as compared to those without BIND. No death occurred in this study population.

Conclusions: Early detection and aggressive therapy with DVET can prevent neonates from brain injury.   


Keywords


Acute bilirubin encephalopathy and phototherapy, Bilirubin induced neurological dysfunction, Double volume exchange transfusion, Kernicterus

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References


Johnson L, Bhutani VK. The clinical syndrome of bilirubin-induced neurologic dysfunction. Semin in Perinatol. 2011;35(3):101-113.

Olusanya BO, Ogunlesi TA, Slusher TM, Why Kernicterus is still a major cause of death and disability in low-income and middle-income countries Arch Dis Child. 2014;99(12):1117-21.

American Academy of Pediatrics, Subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 weeks or more gestation. Pediatrics. 2004;114:297-316.

Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics. 1992;89(5Pt1):809-18.

Johnson L, Brown AK. A pilot registry for acute and chronic Kernicterus in term and near-term infants. Pediatrics. 1999;104(3):736.

Johnson L, Bhutani VK, Karp K, Sevieri EM, Shapiro SM. Clinical report from the pilot USA registry (1992–2004). J Perinatol. 2009; 29(suppl 1):S25-45.

Ip S, Glicken S, Kulig J, O'Brien R, Sege R. Management of neonatal hyperbilirubinemia. Evidence report/technology assessment (Summary). Agency Healthcare Res Qual. 2002;(65):1.

Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics. 1997;99(5):E7.

Murki S, Kumar P, Majumdar S, Marwah N, Narang A. Risk factors for Kernicterus in neonates with non hemolytic jaundice. Indian Pediatric. 2001;38(7):757-62.

Mukhopadhyay K, Chowdhary G, Singh P, Kumar P, Narang A. Neurodevelopmental outcome of acute bilirubin encephalopathy. J Trop Pediatr. 2010;56(5):333-6.

Manning D, Todd P, Maxwell M, Platt MJ. Prospective surveillance study of severe hyperbilirubinemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed. 2007;92(5):342-6.

Sakha SH, Gharehbaghi MM. Exchange transfusion in severe hyperbilirubinemia: An experience in northwest Iran. Turk J Pediatr. 2010;52(4):367-71.

Sa CA, Santos MC, de Carvalho M. Adverse events related to exchange transfusion in hemolytic disease: Ten years’ experience. Rev Paul Pediatr. 2009;27:168-72.

Kumar M, Tripathi S, Singh SN, Anand V. Outcome of neonates with severe hyperbilirubinemia in a tertiary level neonatal unit of North India. Clinical epidemiology and global health .2016;4(2):51-6.

Hoque MM, Hossain MM, Hassan MQ, Uddin ASMN, Begum JA, Chowdhury MAK. Neonatal hyperbilirubinemia requiring exchange transfusion–management and outcome. Bang J Child Health. 2004;28:55-9.

Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med. 2006;354(18):1889-900.

Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ. 2006;175(6):587-90.