To Analyse The Efficacy Of Exchange Transfusion For Neonatal Hyperbilirubinemia And The Influencing Factors

Objective Retrospective study and analysis of volume related ECT innewborns with neonatal hyperbilirubinemia and influencing factors, in order tominimize use of blood as well as to reach the goal of satisfactory outcome ofECT.Methods for analysis We collected118cases of Neonatal Hyper-bilirubinemia, diagnosed and undergone ECT in First Affiliated Hospital ofGuangxi Medical University in the department of neonatal from January2005toDecember2011and collected the general characteristics of patient. According tothe pre ECT serum bilirubin level above cases were divided into4groups：Ⅰ组（～342μmol/L）,Ⅱ组（～428μmol/L）,Ⅲ组（～513μmol/L）,Ⅳ组（≥513μmol/L）.We noted the volume of blood used and post ECT serum bilirubin level. Analyzed the factors that interfere with decreasing tendency of serum bilirubin. Compared the decreasing tendency of serum bilirubin in below three groups namely single volume, in‐between single volume and double volume and double volume blood exchange transfusion after ECT.Data were analyzedusing SPSS13.0Results (1). With the volume increasing, the post ECT serum bilirubin ofeach group decreased significantly (p＜0.05). In the same volume, the bilirubinvalues of each group were statistically significant (P＜0.05).GroupⅠ～Ⅳbilirubin values at the end of single volume exchange transfusion were169μmol/L,215μmol/L,299μmol/L,380μmol/L; GroupⅠ～Ⅳ bilirubin valuesbetween single and double volume exchange transfusion were165μmol/L、198μmol/L、214μmol/L、276μmol/L; GroupⅠ～Ⅳ bilirubin values at the end ofdouble volume exchange transfusion were137μmol/L、178μmol/L、227μmol/L、286μmol/L. Bilirubin of between single and double volume was nosignificant differencesthan that of double volume（p＞0.05）.(2). In the samevolume,serum bilirubin swap out rate of each group were not statisticallysignificant (p＞0.05). Serum bilirubin swap out rate in single, between singleand double, double volume were35.3±12.6%,51.3±6.0%,52.1±9.2%.Initiallybilirubin swap outs fast then gradually slows down. Serum bilirubin swap outrate in first half of exchange transfusion is of0.67in total exchange transfusionprocess. Serum bilirubin swap out rate of between single and double volumewas no significant differencesthan that of double volum（ep＞0.05）.(3).The mostimportant risk factors of hyperbilirubinemia are ABO incompatibility and G-6-PD deficieny. The average bilirubin swap out rate of the single risk factorgroup is significantly higher than that of the multiple risk factors group (p＜0.05).G-6-PD enzyme activity has a significant influence in swap out rate ofbilirubin with a positive correlation.(4). The average values of bilirubin insingle volume is highest,but it is no significant difference in duration ofphototherapy in single volume, double volume and in-between single and doublevolume ECT group.Conclusion (1) The efficacy of ECT is obvious for hyperbilirubine-mia.Serum bilirubin swap out rate is from fast to slow, nothing to do with theinitial bilirubin.(2)The initial bilirubin values is Lower than428μ mol/L,recommend single volume ECT.The initial bilirubin values is higher than428μmol/L, recommend between single and double volume ECT.(3) Neonates withmultiple high risk factors, especially G-6-PD deficiency, are suggestedinctreasing volume to improve bilirubin swap out rate.