Exchange transfusion is a procedure performed within newborn services for the treatmentcorrection of anaemia, hyperbilirubinaemia, and to remove antibodies associated with red blood cell haemolysis. Blood exchange transfusion for infants with severe neonatal. Exchange transfusion should be reserved for infants in whom intensive. The aim is to remove antibody coated red cells and excess bilirubin and increase haemoglobin hb. Hemolytic disease of the newborn introduction and definition. An exchange transfusion reverses or counteracts the symptoms of jaundice or other blood diseases, such as sickle cell anemia. Bilitool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or jaundice in newborns over 35 weeks gestational age. Neonatal jaundice, exchange transfusion, kernicterus. Cbs must be notified of the reason for the transfusion so the exchange unit is prepared appropriately. To continue to observe but no additional intervention repeat test phototherapy exchange blood transfusion unlikely for physiological. Dec 27, 2017 phototherapy, intravenous immune globulin ivig, and exchange transfusion are the most widely used therapeutic modalities in infants with neonatal jaundice. Blood exchange transfusion has become a rare event in most developed countries. Order appropriate volume of blood for exchange order ffp for transfusion midway through and at completion of exchange 10mlkg per transfusion appropriate red cells for exchange will be provided by rch blood bank. The most important piece of the evaluation is distinguishing between unconjugated and conjugated hyperbilirubinemia since a conjugated.
Phototherapy is commonly used for the treatment of neonatal jaundice, whereas exchange transfusion has an important role in the treatment of hyperbilirubinemia of newborns in order to prevent. Jaundice is the most common cause of readmission after discharge from birth hospitalization. Rarely there are other indications for exchange transfusion including volume overload. For table 1 above, phototherapy is usually started at 50% to 70% of the maximum indirect levels. Less common blood group associated with causing severe haemolytic disease of the newborn. High levels of unbound unconjugated bilirubin can cross the bloodbrain barrier and cause. The main indication for neonatal exchange transfusion is to prevent neurological complications kernicterus caused by a rapidlyrising unconjugated bilirubin. Recent advances in the management of neonatal jaundice. 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. The role of intensive phototherapy in decreasing the need. Note that infants with jaundice due to a haemolytic disorder usually benefit from phototherapy but may also require. Exchange transfusion is done when other methods to reduce bilirubin have failed, and rate of rise of bilirubin is approaching dangerous levels risk of.
Jun 01, 2007 about 50% of term and 80% of preterm babies develop jaundice, which usually appears 24 days after birth, and resolves spontaneously after 12 weeks. Neonatal hyperbilirubinemia pediatrics merck manuals. Neonatal jaundice knowledge for medical students and. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Tsb below phototherapy threshold feeding adequately q23h follow up appointment scheduled. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. An exchange transfusion involves removing aliquots of patient blood and replacing with donor blood in order to remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume. American academy pediatrics american academy of pediatrics subcommittee on hyperbilirubinemia. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia an approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation if you have questions about any of the clinical pathways or about the process of creating a.
Exchange the infants blood for normal saline, in increments not to exceed 5% of the estimated total blood volume. The serum bilirubin level required to cause jaundice varies with skin tone and body region, but jaundice usually becomes visible on the sclera at a level of 2 to 3 mgdl 34 to 51 mcmoll and on the face at about 4 to 5 mgdl 68 to 86 mcmoll. Exchange transfusion for jaundiced newborns in the united. In addition to the immediate control of hyperbilirubinemia, an exchange transfusion in immunemediated hemolytic disease also achieves 1 the. Nw newborn clinical guideline exchange transfusion. As early as 1724, juncker, in the conspectus medicinae theoreticopraticae, began distinguishing between true jaundice and. Exchange transfusion for neonatal jaundice cochrane. When they introduced a policy of attempting to keep the tsb level below 340. Exchange transfusion for neonatal hyperbilirubinemia in. Neonatal jaundice an overview sciencedirect topics. With appropriate management, exchange transfusion should rarely be required.
If there are signs of bilirubin encephalopathy an immediate exchange transfusion is recommended. Haemolysis resulting from major or minor blood group antigen incompatibility is the most common cause of early and aggressive haemolysis. Frequency of exchange transfusion in newborns with neonatal. Although medications that impact bilirubin metabolism have been used in studies, drugs are not ordinarily used in unconjugated neonatal hyperbilirubinemia. Exchange transfusion and intravenous immunoglobulin use in. We provide an approach to the use of phototherapy and exchange transfusion in the management of hyperbilirubinemia in preterm infants of exchange transfusion. Jaundice is caused by bilirubin deposition in the skin. Exchange transfusion an overview sciencedirect topics. Original articles phototherapy and exchange transfusion for. The actual bilirubin level at which to implement phototherapy or. Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month.
Nice guideline draft july 2015 page 9 of 43 update information this guideline is an update of nice guideline cg98 published may 2010 and will replace it. Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes. Kalpana malla md pediatrics manipal tea slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Guideline for management of neonatal jaundice birth weight total serum bilirubin mgdl healthy baby sick baby phototherapy exchange transfusion. If values greatly exceed this level, if phototherapy is unsuccessful in reducing the maximum bilirubin level, or if there are signs of kernicterus, exchange transfusion is indicated. Jaundice is not a disease by itself, but rather, a sign that results from hyperbilirubinemia, the excessive accumulation of bilirubin in the blood. Management of hyperbilirubinemia in the newborn infant 35. Recent advances in the management of neonatal jaundice jon f watchko division of newborn medicine, department of pediatrics, university of pittsburgh school of medicine, mageewomens research institute, pittsburgh, pa, usa abstract.
Continue until the total exchange volume is reached. Jaundice that persists after day 14 in term babies and day 21 in preterm babies and is more common in breast fed babies. Jaundice and kernicterus guidelines and tools for health. Blood exchange transfusion neonatal jaundice youtube. In newborn infants, jaundice can be detected by blanching the skin with digital pressure, revealing the underlying color of the skin and subcutaneous tissue. Identify neonates requiring a higher level of care and efficiently coordinate transfer. Indications for exchange transfusion vary see figure 178. Recognize indications for initiating, continuing and discontinuing phototherapy andor exchange transfusion. Adverse events related to exchange transfusion in newborn infants. Process of blood exchange transfusion for neonatal jaundice by umbilical catheter alshifa hospital nicu palestinegaza. Exchange transfusion page 3 of 12 neonatal guideline fresh frozen plasma ffp should also be ordered with the prcs. Jaundice is common in the neonatal period, affecting 5060% of newborns. The implications of this observation and the use of evoked potential recording in neonatal jaundice are discussed. Phototherapy is commonly used for the treatment of neonatal jaundice, and homebased phototherapy is now being.
Discuss the indications for exchange transfusion with the appropriate specialist. Jaundice occurring within the first 24 hours of life should always be considered pathological. 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. Neonatal jaundice is common and is usually a benign condition in the newborn affecting 50% of term infants and 80% of preterm infants in first week of life. Breastfed babies who require phototherapy should continue to breastfeed unless clinically contraindicated due to other pathology. Jaundice is a blood disease thats fairly common in newborns during. Clinical presentation of hdn varies from mild jaundice and anemia to hydrops fetalis with ascites, pleural and pericardial effusions. Ffp should never be added to the bag of prcs, but rather administered in a separate. For grade evaluation of interventions for neonatal jaundice. Treat newborns, when indicated, with phototherapy or exchange transfusion. The condition may be benign or may place the neonate at risk for multiple complicationsuntoward effects.
Exchange transfusion 200911 exchange transfusion see jaundice guideline exchange transfusion replaces withdrawn baby blood with an equal volume of donor blood discuss all cases with neonatal consultant indications anaemia at birth from blood group incompatibilities if no transfusion given inutero, to remove antibodies and correct. 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 exchange transfusion in a nontertiary hospital setting. The need for exchange transfusion has been reduced due to improved bilirubin surveillance, phototherapy, immunoprophylaxis with anti rh ig, and intrauterine transfusion of nonmaternal rbcs. As a result, many pediatricians may not have performed or even seen one. June 2015, 1 of 14 neonatal clinical practice guideline.
In the case of infants nearing exchange transfusion level, the infant should not come out of phototherapy to feed as this is a. If phototherapy indicated determine if tsb is within 50. Phototherapy is generally very effective for newborn jaundice and has few side effects, although your baby may develop a temporary rash and diarrhoea. The medical term for jaundice in babies is neonatal jaundice. Although there are many welldescribed risks with exchange transfusion, mortality should be low less than 0. The term jaundice comes from the root jaune, the french word for yellow. The assessment of jaundice must be performed in a welllit room or, preferably, in daylight at a window. Early aggressive phototherapy, admission to scn and consideration for exchange transfusion may be necessary. Apr 19, 2017 process of blood exchange transfusion for neonatal jaundice by umbilical catheter alshifa hospital nicu palestinegaza.
Exchange transfusion if your baby has a very high level of bilirubin in their blood or phototherapy hasnt been effective, they may need a complete blood transfusion, known as an exchange transfusion. An exchange transfusion is indicated for any infant in whom the degree of hyperbilirubinaemia cannot be adequately controlled by phototherapy alone. Neonatal exchange transfusion in a nontertiary hospital. Exchange transfusion et in neonates is used to treat severe hyperbilirubinaemia and anaemia secondary to haemolytic disease of the newborn hdn. Exchange transfusion for severe neonatal hyperbilirubinemia.
Exchange transfusion et, however, is considered to be the most effective and quickest method to lower the bilirubin level in infants at high risk of kernicterus. Exchange transfusion neonatal clinical guideline v1. Effect of exchange transfusion on brain perfusion and electrocortical brain activity in newborn lambs. Opisthotonus severe hyperextension causing backward arching of the head, neck, and spine. Jaundice 2 exchange transfusion is the replacement of blood from newborn infants with elevated bilirubin level in their blood stream with donor blood containing normal bilirubin levels. Aug 15, 2010 screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy this is a corrected version of the putting prevention into practice that appeared in print.
Within 23 mgdl of exchange transfusion should be referred to immediate inpatient. Jaundice is a yellow discoloration of the skin and eyes caused by hyperbilirubinemia elevated serum bilirubin concentration. Manage neonatal hyperbilirubinemia, including referral to the neonatal intensive care unit for exchange transfusion. An approach to the management of hyperbilirubinemia in the. Hyperbilirubinemia is the elevation of serum bilirubin levels that is related to the hemolysis of rbcs and subsequent reabsorption of unconjugated bilirubin from the small intestines.
Double volume exchange transfusion is mainly used for the management of. 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 et provides rapid reduction of circulating bilirubin, so it could represent appropriate treatment in many cases. Guideline coverage includes nicu kemh, nicu pch and nets wa. If you continue browsing the site, you agree to the use of cookies on this website. Double volume exchange transfusion clinical pathway icu. The effectiveness of intensive phototherapy in reducing exchange. Neonatal jaundice can affect up to 84% of term newborns and is often a benign process that is quickly corrected once identified.
A total of 143 patients underwent 207 exchange transfusions. In using the guidelines for phototherapy and exchange transfusion listed, the. 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. Guideline treatment of the hemolytic and nonhemolytic 2500 gram newborn see. Neonatal blood transfusion and exchange transfusion. Separate guidelines are available for the evaluation and management of late onset jaundice 710 days or later and prolonged jaundice sbr 200.
New recommendations have been added for the types of phototherapy used for babies with neonatal jaundice. 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. Efficiently obtain appropriate consultative services for infants with cholestatic jaundice or possible pathologic underlying condition. Blood for exchange transfusion should meet the following criteria. Age h bilirubin mgdl phototherapy exchange transfusion.
A total serum bilirubin level at or above the exchange transfusion level should be. Evaluation and treatment of neonatal hyperbilirubinemia. Is ebt a safe and effective treatment for severe neonatal hyperbilirubinaemia. This guideline also covers partial exchange for treatment of polycythaemia. Aimpurpose of guideline to help staff manage significant jaundice safely and prevent complications of brain damage and kernicterus. 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. 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. Newborn exchange transfusion page 2 of 8 group o, rh negative blood is the most common choice for neonatal exchange units subsequent transfusions. Additional options include pharmacotherapy in the form of phenobarbital etc. For most babies, jaundice is not an indication of an underlying disease, and this early jaundice termed physiological jaundice is generally harmless. Jaundice in the newborns jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. Case based pediatrics chapter university of hawaii. Intensive phototherapy, exchange transfusion, neonatal jaundice.
Exchange transfusion et is effective in preventing bilirubininduced neurologic dysfunction in infants with severe hyperbilirubinemia. Neonatal exchange transfusion neonatal 5 partial volume exchange to lower hematocrit to lower hematocrit. Neonatal jaundice symptoms, diagnosis and treatment. The procedure involves slowly removing the persons blood and replacing it with fresh donor blood or plasma. To answer this question in general terms, safety and efficacy data see below will be evaluated from clinical trials comparing ebt with either no. Exchange transfusion is the most rapid method to acutely lower the serum bilirubin concentration. Phototherapy decreases the incidence of severe hyperbilirubinemia in newborns.
C 5 phototherapy decreases the need for exchange transfusion in newborns with severe hyperbilirubinemia. Exchange transfusion occupies a unique place in the history of neonatal jaundice because it was the first intervention to permit effective control of severe hyperbilirubinemia and prevent kernicterus. Neonatal jaundice national institute for health and care. Management no action for the vast majority of babies with physiological jaundice measure the serum bilirubin the level of serum bilirubin actually indicates what treatment is required. Outcome of exchange blood transfusions done for neonatal jaundice in. Advances in the clinical assessment strategies used to identify neonates at risk for the development of severe hyperbilirubinemia and bilirubin neurotoxicity, as. Screening of infants for hyperbilirubinemia to prevent. Hyperbilirubinemia consensus emory school of medicine. A neonate refers to an infant in the first 28 days of life. Twenty years later, oski and naiman4 published a nomogram that was constructed by diamond and allen, specifically for use with infants with. Exchange transfusion for jaundiced newborns in the united states 1 by. Neonatal exchange transfusion sydney local health district. Tsb within 2 mgdl of exchange transfusion threshold tsb within 24 mgdl of exchange transfusion threshold tsb 4 mgdl below exchange transfusion threshold or down iv not routinely indicated evaluate for discharge. Currently, phototherapy and exchange transfusion are two major effective therapeutic modalities available toady.
Bilisphere 360 is effective in reducing needs for exchange transfusion and duration of phototherapy. Facilitybased constraints to exchange transfusions for neonatal. Nursing guideline for treating neonatal jaundice with. Neonatal jaundice pdf 525p this note covers the following topics. Outcome of exchange blood transfusions done for neonatal. It is also the most common cause for hospital readmission for neonates post birth. This topic focuses on recognizing and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinemia. An et is indicated when hyperbilirubinemia remains at dangerous levels despite intensive phototherapy and is particularly useful when there is excessive haemolysis. To exchange all or part of an infants blood supply forcertain medical conditions is called exhangetransfusion. A double volume exchange transfusion is replacingthe babys total blood volume twice, leaving theintravascular amount the same.
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