| Objective By analyzing the short-term clinical outcomes of severe neonatal hyperbilirubinemia treated with peripheral arteriovenous synchronous exchange transfusion,the relationship between the type of disease,the effect of exchange transfusion and adverse outcomes and exchange transfusion time was discussed for clinical reference.Methods The clinical data of severe neonates hyperbilirubinemia who received peripheral arteriovenous synchronous blood exchange transfusion were retrospectively analyzed from January 2015 to December 2016.Ninety-eight cases were divided into acute bilirubin encephalopathy group and non-acute bilirubin encephalopathy group according to their clinical manifestations,cranial MRI and BAEP.Relevant data were collected and compared between the two groups in terms of disease types,B/A value before and after exchange transfusion,total bilirubin,white blood cells,red blood cells,hemoglobin and blood before and after exchange transfusion.Plate,to understand the effect of exchange transfusion,and to compare the two groups with gestational age,age of onset,exchange time,the first hospital grade and so on.Results 1.Ninety-eight neonates were enrolled and the ratio of male:female was 1:1,The mean gestational age was(38.7±1.2)weeks,the mean birth weight was(3275.1 ±483.68)grams.The main types of diseases were blood group incompatibility,homologous immune hemolysis,58 cases(59.23%).During this group there were 39 cases of ABO incompatibility(39.8%),16 cases of Rh incompatibility(16.33%),3 cases of C3d incompatibility(3.1%),2 cases of infection(2.0%),2 cases of cranial hematoma(2.0%),2 cases of adrenal hematoma(2.0%)and 34 cases of unknown reason for hyperbilirubinemia(34.7%).3.After exchange transfusion,the total serum bilirubin,platelet level and the white blood cell counts were decreased dramatically comparing with the pre-exchange’s level,with significant difference(t=15.85,P<0.05;t=13.75,P<0.05;t=4.06,P<0.05).Hemoglobin were increased,with significant difference(t=4.41,P<0.05).3.Compared with 54 cases without acute bilirubin encephalopathy,44 cases with acute bilirubin encephalopathy,there are no significant difference in gestational age,age of onset and bilirubin before and after exchange transfusion;the interval between onset and exchange transfusion.In acute bilirubin encephalopathy group the mean age of blood exchange transfusion was(5.9<3.4)days,and that in non-acute bilirubin encephalopathy group was(5.9<3.4)days.(4.1 + 3.7)d with significant difference(t = 2.46,P<0.05).44 cases who had bilirubin encephalopathy had significant difference at the lower hospital level of first hospitalization and higher B/A value before exchange transfusion(t=2.46,P<0.05;t=6.15,P<0.05;t=3.21,P<0.05),comparing with other 54 cases without bilirubin encephalopathy.Conclusion 1.Hemolytic disease is the most common cause of neonatal severe hyperbilirubinemia.Severe hyperbilirubinemia caused by unknown causes should be paid attention to.2.Peripheral arteriovenous synchronous blood exchange transfusion is safe and effective to manage severe hyperbilirubinemia.It is a direct,rapid and effective treatment for severe hyperbilirubinemia.3.Early bilirubin damage to nerve cells is reversible,but clinical lack of specific symptoms,easy to miss diagnosis,missed the best exchange window,eventually leading to bilirubin encephalopathy,and the calculation of B/A value is conducive to grasping the best exchange window period,reduce and avoid the occurrence of acute bilirubin encephalopathy.4.Streng-thening the understanding of hyperbilirubinemia in primary hospitals,further promoting hourly bilirubin,establishing follow-up mechanism and educating parents,timely referral to qualified tertiary hospitals can reduce the occurrence of bilirubin encephalopathy. |
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