Issues Related To The Exchange Transfusion Therapy Of Neonatal Hyperbilirubinemia

ObjectiveBy analyzing the bilirubin,clinical manifestations,treatment andshort-term prongnosis of the severe neonatal hyperbilirubinemia patients, toinvestigate the control of blood transfusion therapy.MethodCollect the information of severe hyperbilirubinemia infants who meetthe ECT standard but without ECT into not ECT group,then select theinfant who experienced exchange transfusion into ECT group ensure thatthe sex composition, gestational age, total serum bilirubin, B/A ratio haveno statistically significant difference between two groups, then analysis theclinical characteristics,treatment,prognosis of the two groups.ResultA total of270newborns enrolled in the study,the ECT group has thesame cases with the not ECT group. Each group was divided into fourperiods(younger than24hours old,24~48hours old,48~72hours oldand older than72hours old) by the age of admission. The gendercomposition, gestational age, proportion of vaginal delivery, birth weight,admission weight and body mass loss had no statistically significantdifference between two groups in four periods(P>0.05). The total serumbilirubin of ECT group and not ECT group is411.38±70.38μmol/L,412.78±69.68μmol/L, it was no statistically significant difference betweenthem.(t=0.16,P=0.87)Of the infants older than72hours old at admission,the BIND score of ECT group is higher than the not ECT group′s, and the difference was statistically significant(t=2.46,P=0.02). ABO hemolyticdisease (55.6%) is the main reason for hyperbilirubinemia of the study,followed by extravascular hemolysis (7.0%). There were84newborns whohad hemolytic disease in ECT group,31(36.9%)of them were used IVIG,but only5infants (5.9%)were used before ECT. The not ECT group had73cases of hemolytic disease,55cases(75.3%) of the IVIG using.Thedifference of results of NBNA(χ2=1.17,P=0.28)and BAEP(χ2=1.97,P=0.16)between two groups was not statistically significant.15cases underwentMRI examination in ECT group,abnormal was9cases; and3out of5cases in not ECT group had abnormal MRI results.129/135infantsdeveloped adverse events attributable to ECT, most of the adverse eventswere metabolic disturbances and the severe adverse events were registeredin7infants (5.2%). For the infants younger than24hours old,48~72hoursold and older than72hours old, ECT group′s hospitalization time islonger than the not ECT group′s, the difference was statistically significantin the last period.(t=3.84, P<0.001)ConclusionECT is an invasive treatment of high-risk, as the guideline is not veryprecise, a comprehensive analysis of the cause, signs of ABE, foundationstatus of the infants can help making a better decision, especially for theinfants older than72hours old. For the infants undergoing hemolyticdisease and without signs of ABE, using IVIG and intensive phototherapymay reduce the frequency of exchange transfusion therapy.