Clinical Analysis Of Exchange Transfusion Treatment For Neonatal Hyperbilirubinemia

Objective To investigate the cause of neonatal hyperbilirubinemia,therelationship between the effectiveness and risk of exchange transfusion（ET）and acute bilirubin encephalopathy(ABE).Methods Retrospective analysis was carried out on the clinical dataof516neonates admitted our department and accepted ET procedures fromJanuary2001to December2011.Results⑴In present study,200neonates without ABE,175neonates had subtleABE,84neonates had moderate ABE and57neonates had advanced ABE.Atotal of536ET procedures were performed in516neonates during the studyperiod.2ET procedures were performed in14neonates，3ET procedureswere performed in3neonates.⑵The most common cause of hyperbilirubinemia was ABOisoimmunization(38%).Rh isoimmunisation, Hemolytic disease ofnewborns combined weight loss of more than10%of the birth weigh and weight loss of more than10%of the birth weight was determined as a causeof hyperbilirubinaemia in6.8%,10.9%and4.7%of the patients, respectively.With the the ABE severity of hemolytic disease of newborns combinedweight loss of more than10%of the birth weigh proportion increased,butABO isoimmunization roportion reduced（P＜0.05）.⑶As severity of ABE,ages of admission,onset and duration ofhyperbilirubinemia increased（P＜0.05）.⑷The exchange rate of TSB was53.6%after ET procedures wereperformed.As severity of ABE,TSB levels before and after ET immediatelyinreased,however,the exchange rate of TSB reduced（P＜0.05）.⑸Among the adverse events related to ET procedure,Hyperglycemia(68.8%),thrombocytopenia (61.0%),and hypocalcemia(20.0%)were noted commonly（P＜0.05）.⑹Serious adverse events related to ET was observed in11.2%ofthe516neonates.With the the ABE severity of the incidences graduallyincreased（P＜0.05）.Among the serious adverse events related to ET,apnea(4.7%),heart failure(2.1%) and Necrotizing Enterocolitis(NEC)(2.1%)were noted commonly.Conlusions⑴The most common cause of hyperbilirubinemia was ABOisoimmunization,weight loss of more than10%of the birth weigh wasanother important cause.In order to prevent adverse effects of ET, serum bilirubin levels should be closely monitored in newborns with ABOimmunization and reasonable feeding is necessary.⑵ET,which can effectively reduce the TSB level in the body, wasworth of the first-line approach treatmenting severe neonatalhyperbilirubinemia.However,as severity of ABE,the effectiveness of ETprocedures reduced.⑶Biochemical abnormalities in the blood was the most commonadverse events related to ET.Serious adverse events related to ET were notuncommon，and as severity of ABE,the effectiveness of ET proceduresreduced.⑷However,ET was needed to be weighted the advantages anddisadvantages before performed,according to the presence or absence ofABE and the degree of ABE.Because of the severe adverse events related toET in health infants, ET should be delayed until the risk of bilirubinencephalopathy is as high as the risks of severe adverse events related to ETfrom the procedure itself.ET procedure was performed on ABE，especiallyadvanced ABE,preparing countermeasures and intensive care is necessary. Objective To assess the cost-benefit of exchange transfusion（ET) inthe treatment of different severity of acute bilirubin encephalopathy(ABE).Methods Retrospective analysis was carried out on the clinical dataof137ABE neonates admitted our department from January2009toDecember2010.Results⑴The enrolled neonates were divided into four groups by ABEseverity and interventions:40neonates in Group SE (Subtle ABE with ET),29in Group SNE (Subtle ABE without ET),49in Group ME (Moderate toadvanced ABE with ET), and19in Group MNE (Moderate to advancedABE without ET).⑵The Total Serum Bilirubin (TSB) levels, TSB:Albumin molarratio(B/A), the proportion of blood group incompatibility and thehospitalization costs per capita in Group SE were obviously higher thanthose in Group SNE (P<0.05). Without death in subtle ABE, the rate ofpoor outcomes in Group SE,15.0%was similar to that of Group SNE,13.8%. The maximum benefit-cost ratio of Group SE and Group SNE was87.5and121.5, respectively. ⑶The TSB levels, B/A, the proportion of blood group incompatibilityand the hospitalization costs per capita in Group ME significantly exceededthose in Group MNE (P<0.05). Five neonates died in moderate toadvanced ABE, and the incidence of poor outcomes in Group ME,32.7%was2.1times to that of Group MNE,5.8%. The maximum benefit-costratio of Group ME and Group MNE was89.8and160.0, respectively. TheTSB levels and B/A in Group ME exceeded those in Group SE (P<0.05),the incidence of poor outcomes in Group ME was2.2times to that ofGroup SE, whereas the hospitalization costs per capita in Group ME weresimilar to those in Group SE (P>0.05). Morbidity of the severe adverseevents associated with ET in Group ME,12.2%was2.4times to that ofGroup SE,5.0%.Conclusions⑴The cost-benefit analysis indicated that ET was worth of thefirst-line approach rescuing subtle ABE. However, ET was needed to beweighted the advantages and disadvantages before performed on moderateor advanced ABE.⑵It is necessary to implement phototherapy among neonates withpathologic jaundice, which is crucial for diminishing mortality andmorbidity of ABE and lowering medical resource consumption.