Abstract
Purpose: Urgent treatment in newborns with severe hyperbilirubinemia is the removal of bilirubin from the body by exchange transfusion (ET) as the main treatment modality. The aim of this study was to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two neonatal ıntensive care units (NICUs).
Materials and Methods: The clinical data were collected of 28 newborns who had undergone rescue exchange transfusions after hospitalization with a diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital.
Results: Evaluation was made of 28 newbons with a median serum bilirubin level on admission of 31.2 (20.3-36.8) mg/dL. The leading cause for exchange transfusion was hemolytic jaundice (67.8%), followed by inadequate feeding (14%). The most common cause of hyperbilirubinemia was Rh incompatibility. The reported rate of adverse events associated with exchange transfusion was 71%. The most common complications due to ET were thrombocytopenia and anemia. Four infants died after the ET therapy. Acute bilirubin encephalopathy (ABE) was detected in 39% of the newborns. Serum bilirubin and bilirubin/albumin ratios were found to be high in newborns with ABE.
Conclusion: Newborns with severe hyperbilirubinemia, especially when related to hemolytic jaundice, may need rescue ET. As newborns with severe hyperbilirubinemia with a high bilirubin/albumin ratio are at risk of ABE, ET should be considered in these cases
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Dear Editor Please accept this paper and the attached main text, Rescue exchange transfusion in severe neonatal hyperbilirubinemia: a two-center experience", which we would like to submit for possible publication to Çukurova Medical Journal. Urgent treatment in newborns with severe hyperbilirubinemia is removal of bilirubin from the body by exchange transfusion as a main treatment modality. We aimed to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two-NICUs. We collected clinical data of 28 newborns undergone rescue exchange transfusion after hospitalization with diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital Results: The median postnatal age at admission was 3 (1-6) days. The most common cause of hyperbilirubinemia was Rh incompatibility. After ET, serum bilirubin levels, albumin, AST and count of thrombocyte were decreased. The most common complications due to ET were thrombocytopenia and anemia. Acute ABE was detected in 39% of patients. Serum bilirubin and bilirubin / albumin ratios were found to be high in patients with ABE Ethical approval was provided from the Human Research Ethics Committee of Cumhuriyet University before the study, and the study was carried out in accordance with the Helsinki Declaration. Verbal and written informed consents for the study to participation and publication were obtained from patients and their parents, on the condition that patients' anonymity must be preserved. We confirm that this study is original, no conflict of interest related to this study and has not been published elsewhere nor is it currently under consideration for publication elsewhere. We hope that you will afford us the opportunity to be accepted as an author. For any information concerning this manuscript, please contact me preferably by fatihkilicbay@cumhuriyet.edu.tr Thank you for your time and consideration of this manuscript. I look forward to hearing from you soon. Yours sincerely, Dr.Fatih Kılıçbay, MD, Division of Neonatology, Department of Pediatrics, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey. Zip Code: 58140. Phone: +90 0346 258 3033/ +90 fatihkilicbay@cumhuriyet.edu.tr , Fax: 03462580032. E-mail: fatihkilicbay@cumhuriyet.edu.tr
References
- Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F et al. Turkish Neonatal Jaundice Registry Collabolators. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One.2018;13:e0193108.
- Olusanya BO, Ogunlesi TA, Kumar P, Boo NY, Iskander IF, de Almeida MF et al. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Pediatr.2015;15:39.
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics.2004;114:297-16.
- Hameed NN, Na' Ma AM, Vilms R, Bhutani VK. Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology. 2011;100:57-3.
- English M, Ngama M, Musumba C, Wamola B, Bwika J, Mohammed S et al. Causes and outcome of young infant admissions to a Kenyan district hospital. Arch Dis Child. 2003;88:438-43.
- Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379:445-52.
- Çoban A, Türkmen MK, Gürsoy T. Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turk Arch Pediatr. 2018;53:172-9.
- Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L et al. Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol. 2020;40:1506-12.
- Nasseri F, Mamouri GA, Babaei H. Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J.2006;27:1827-30.
- Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics.1992;89:809-18.
- Ives NK. Management of neonatal jaundice. Paediatr Child Health. 2011;21:270-6.
- Bozkurt Ö, Yücesoy E, Oğuz B, Akinel Ö, Palali MF, Ataş N. Severe neonatal hyperbilirubinemia in the southeast region of Turkey. Turk J Med Sci. 2020;50:103-9.
- Gamaleldin R, Iskander I, Seoud I, Aboraya H, Aravkin A, Sampson PD et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics. 2011;128:e925-31.
- Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;395:795-08.
- Sasmaz I. Glucose-6-phosphate dehydrogenase deficiency. Turk Arch Pediatr 2009;44:35-8.
- Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics.1997;99:E7.
- Johnson L, Bhutani VK. The clinical syndrome of bilirubin-induced neurologic dysfunction. Semin Perinatol. 2011;35:101-13.
- Le Pichon JB, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: definitions, diagnosis and treatment of the Kernicterus Spectrum Disorders (KSDs). Curr Pediatr Rev. 2017;13:199-09.
- Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-01.
- Malla T, Singh S, Poudyal P, Sathian B, Bk G, Malla KK. A Prospective study on exchange transfusion in neonatal unconjugated hyperbilirubinemia--in a tertiary care hospital, Nepal. Kathmandu Univ Med J. 2015;13:102-8.
- Battersby C, Michaelides S, Upton M, Rennie JM; Jaundice Working Group of the Atain (Avoiding Term Admissions Into Neonatal units) programme, led by the Patient Safety team in NHS Improvement. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 2017;7:e016050.
- Bujandric N, Grujic J. Exchange transfusion for severe neonatal hyperbilirubinemia: 17 years' experience from Vojvodina, Serbia. Indian J Hematol Blood Transfus.2016;32:208-14.
- Lopriore E, Rath ME, Liley H, Smits-Wintjens VE. Improving the management and outcome in haemolytic disease of the foetus and newborn. Blood Transfus. 2013;11:484-6.
- Çayönü N, Bülbül A, Uslu S, Bolat F, Güran Ö, Nuhoğlu A. Indirect hyperbilirubinemia in newborn infants change over the last decade. Med Bull Sisli Etfal Hosp. 2011;45:85-3.
- Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria. World J Pediatr. 2009;5:51-5.
- Slusher TM, Zipursky A, Bhutani VK. A global need for affordable neonatal jaundice technologies. Semin Perinatol. 2011;35:185-91.
- Isa HM, Mohamed MS, Mohamed AM, Abdulla A, Abdulla F. Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency. Korean J Pediatr. 2017;60:106-11.
- Atay E, Bozaykut A, Ipek IO. Glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr. 2006;52:56-8
- Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr. 2006;73:39-1.
- Zuppa AA, Sindico P, Antichi E, Carducci C, Alighieri G, Cardiello V et al. Weight loss and jaundice in healthy term newborns in partial and full rooming-in. J Matern Fetal Neonatal Med. 2009;22:801-5.
- Monpoux F, Dageville C, Mailotte AM, De Semet S, Casagrande F, Bouttè P. High-dose intravenous immunoglobulin therapy and neonatal jaundice due to red blood cell alloimmunization. Arch Pediatr. 2009;16:91289-94.
- Bayoumi YA, Bassiouny YA, Hassan AA, Gouda HM, Zaki SS, Abdelrazek AA. Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h fol- lowing cesarean section? A prospective randomized observation- al study on 2998 patients. J Matern Fetal Neonatal Med 2016;29:1339-43.
- Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics.2007;120:27-2.
- Patra K, Storfer-Isser A, Siner B, Moore J, Hack M. Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr.2004;144:626-31.
- Watchko JF, Jeffrey Maisels M. Enduring controversies in the management of hyperbilirubinemia in preterm neonates. Semin Fetal Neonatal Med. 2010;15:136-40.
- Okulu E, Erdeve Ö, Tuncer O, Ertuğrul S, Özdemir H, Çiftdemir Aladağ N et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2020:17–2.
- Murki S, Kumar P, Majumdar S, Marwaha N, Narang A. Risk factors for kernicterus in term babies with non-hemolytic jaundice. Indian Pediatr. 2001;38:757-62.
- Chitty HE, Ziegler N, Savoia H, Doyle LW, Fox LM. Neonatal exchange transfusions in the 21st century: a single hospital study. J Paediatr Child Health. 2013;49:825-32.
Abstract
Amaç: Şiddetli hiperbilirubinemili yenidoğanlarda bilirubinin vücuttan uzaklaştırılabilmesi için, kan değişimi (KD) acil bir tedavi yöntemidir. İki yenidoğan yoğun bakım ünitesinde (YYBÜ) KD uygulanan şiddetli hiperbilirubinemili yenidoğanların sonuçlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bir üniversite hastanesi ve bir devlet hastanesinin YYBÜ'lerinde ağır hiperbilirubinemi tanısı ile hastaneye yatırıldıktan sonra kan değişimi yapılan 28 yenidoğanın klinik verilerini topladık.
Bulgular: Başvuru sırasında medyan serum bilirubin düzeyi 31,2 (20,3-36,8) mg/dL olan 28 yenidoğan çalışmaya alındı. En sık kan değişimi nedeni hemolitik sarılık (%67.8) ve bunu uygun beslenememe (%14) takip ediyordu. Hiperbilirubineminin en sık nedeninin Rh uyuşmazlığı olduğu bulundu. Kan değişimi ile ilişkili bildirilen advers olay oranı %71 idi. KD'ye bağlı en sık görülen komplikasyonlar trombositopeni ve anemi idi. İşlem sonrası 4 bebek hayatını kaybetti. Yenidoğanların %39'unda akut bilirubin ensefalopatisi (ABE) tespit edildi. ABE'li yenidoğanlarda serum bilirubin ve bilirubin/albümin oranları yüksek bulundu.
Sonuç: Özellikle hemolitik sarılıkla ilişkili ciddi hiperbilirubinemisi olan yenidoğanların kurtarma ET'sine ihtiyacı olabilir. Bilirubin/albümin oranları yüksek, şiddetli hiperbilirubinemisi olan yenidoğanlar ABE açısından risk altında olduğundan bu olgularda ET düşünülmelidir
References
- Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F et al. Turkish Neonatal Jaundice Registry Collabolators. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One.2018;13:e0193108.
- Olusanya BO, Ogunlesi TA, Kumar P, Boo NY, Iskander IF, de Almeida MF et al. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Pediatr.2015;15:39.
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics.2004;114:297-16.
- Hameed NN, Na' Ma AM, Vilms R, Bhutani VK. Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology. 2011;100:57-3.
- English M, Ngama M, Musumba C, Wamola B, Bwika J, Mohammed S et al. Causes and outcome of young infant admissions to a Kenyan district hospital. Arch Dis Child. 2003;88:438-43.
- Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379:445-52.
- Çoban A, Türkmen MK, Gürsoy T. Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turk Arch Pediatr. 2018;53:172-9.
- Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L et al. Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol. 2020;40:1506-12.
- Nasseri F, Mamouri GA, Babaei H. Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J.2006;27:1827-30.
- Newman TB, Maisels MJ. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. Pediatrics.1992;89:809-18.
- Ives NK. Management of neonatal jaundice. Paediatr Child Health. 2011;21:270-6.
- Bozkurt Ö, Yücesoy E, Oğuz B, Akinel Ö, Palali MF, Ataş N. Severe neonatal hyperbilirubinemia in the southeast region of Turkey. Turk J Med Sci. 2020;50:103-9.
- Gamaleldin R, Iskander I, Seoud I, Aboraya H, Aravkin A, Sampson PD et al. Risk factors for neurotoxicity in newborns with severe neonatal hyperbilirubinemia. Pediatrics. 2011;128:e925-31.
- Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;395:795-08.
- Sasmaz I. Glucose-6-phosphate dehydrogenase deficiency. Turk Arch Pediatr 2009;44:35-8.
- Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics.1997;99:E7.
- Johnson L, Bhutani VK. The clinical syndrome of bilirubin-induced neurologic dysfunction. Semin Perinatol. 2011;35:101-13.
- Le Pichon JB, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: definitions, diagnosis and treatment of the Kernicterus Spectrum Disorders (KSDs). Curr Pediatr Rev. 2017;13:199-09.
- Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-01.
- Malla T, Singh S, Poudyal P, Sathian B, Bk G, Malla KK. A Prospective study on exchange transfusion in neonatal unconjugated hyperbilirubinemia--in a tertiary care hospital, Nepal. Kathmandu Univ Med J. 2015;13:102-8.
- Battersby C, Michaelides S, Upton M, Rennie JM; Jaundice Working Group of the Atain (Avoiding Term Admissions Into Neonatal units) programme, led by the Patient Safety team in NHS Improvement. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 2017;7:e016050.
- Bujandric N, Grujic J. Exchange transfusion for severe neonatal hyperbilirubinemia: 17 years' experience from Vojvodina, Serbia. Indian J Hematol Blood Transfus.2016;32:208-14.
- Lopriore E, Rath ME, Liley H, Smits-Wintjens VE. Improving the management and outcome in haemolytic disease of the foetus and newborn. Blood Transfus. 2013;11:484-6.
- Çayönü N, Bülbül A, Uslu S, Bolat F, Güran Ö, Nuhoğlu A. Indirect hyperbilirubinemia in newborn infants change over the last decade. Med Bull Sisli Etfal Hosp. 2011;45:85-3.
- Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria. World J Pediatr. 2009;5:51-5.
- Slusher TM, Zipursky A, Bhutani VK. A global need for affordable neonatal jaundice technologies. Semin Perinatol. 2011;35:185-91.
- Isa HM, Mohamed MS, Mohamed AM, Abdulla A, Abdulla F. Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency. Korean J Pediatr. 2017;60:106-11.
- Atay E, Bozaykut A, Ipek IO. Glucose-6-phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr. 2006;52:56-8
- Bhat SR, Lewis P, David A, Liza SM. Dehydration and hypernatremia in breast-fed term healthy neonates. Indian J Pediatr. 2006;73:39-1.
- Zuppa AA, Sindico P, Antichi E, Carducci C, Alighieri G, Cardiello V et al. Weight loss and jaundice in healthy term newborns in partial and full rooming-in. J Matern Fetal Neonatal Med. 2009;22:801-5.
- Monpoux F, Dageville C, Mailotte AM, De Semet S, Casagrande F, Bouttè P. High-dose intravenous immunoglobulin therapy and neonatal jaundice due to red blood cell alloimmunization. Arch Pediatr. 2009;16:91289-94.
- Bayoumi YA, Bassiouny YA, Hassan AA, Gouda HM, Zaki SS, Abdelrazek AA. Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h fol- lowing cesarean section? A prospective randomized observation- al study on 2998 patients. J Matern Fetal Neonatal Med 2016;29:1339-43.
- Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics.2007;120:27-2.
- Patra K, Storfer-Isser A, Siner B, Moore J, Hack M. Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr.2004;144:626-31.
- Watchko JF, Jeffrey Maisels M. Enduring controversies in the management of hyperbilirubinemia in preterm neonates. Semin Fetal Neonatal Med. 2010;15:136-40.
- Okulu E, Erdeve Ö, Tuncer O, Ertuğrul S, Özdemir H, Çiftdemir Aladağ N et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2020:17–2.
- Murki S, Kumar P, Majumdar S, Marwaha N, Narang A. Risk factors for kernicterus in term babies with non-hemolytic jaundice. Indian Pediatr. 2001;38:757-62.
- Chitty HE, Ziegler N, Savoia H, Doyle LW, Fox LM. Neonatal exchange transfusions in the 21st century: a single hospital study. J Paediatr Child Health. 2013;49:825-32.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Publication Date | March 31, 2022 |
| Acceptance Date | January 4, 2022 |
| Published in Issue | Year 2022 Volume: 47 Issue: 1 |
