Efficacy of Single- and Double-Volume Exchange Transfusion for Neonatal Hyperbilirubinemia
Single- and Double-Volume Exchange Transfusion for Neonatal Hyperbilirubinemia
Abstract
Background: To investigate the efficacy and safety of single- and double-volume exchange transfusion for neonatal hyperbilirubinemia (HB) and compare their effects on the internal environment of newborns.
Methods: The clinical data of 96 HB newborns admitted to and treated in our hospitals from January 2016 to October 2021 were retrospectively analyzed. Then, these newborns were divided into single volume group (80-110 mL/kg, n=48) and double volume group (150-180 mL/kg, n=48) by the exchange volume per unit body mass. The hematological indicators [total serum bilirubin (TSB), peripheral blood red blood cell (RBC) count, white blood cell (WBC) count, platelet (PLT) count, serum albumin (ALB), prothrombin time (PT) and activated partial thromboplastin time (APTT)], and changes in inner-environment indexes (blood gas, blood glucose, acid-base and electrolyte levels) were compared between the two groups of newborns before treatment and after once treatment. Additionally, the adverse reactions of exchange transfusion in the two groups of newborns were recorded.
Results: The mean exchange volume was (96.79±11.52) mL/kg and (160.74±10.19) mL/kg, and the exchange time was (98.66±19.86) min and (110.33±22.71) min in single volume group and double volume group, respectively. The differences were statistically significant (P=0.009). The average length of hospital stay was (9.14±3.78) d in single volume group and (9.75±4.05) d in double volume group, displaying no statistically significant difference (P=0.448). The total bilirubin (TBIL) and indirect bilirubin levels significantly declined after exchange transfusion compared with those before exchange transfusion (P=0.032), and they were significantly lower in double volume group than those in single volume group after exchange transfusion (P=0.007). The TBIL exchange rate was significantly higher in double volume group than that in single volume group [(58.60±3.73)% vs. (50.57±3.45)%, P=0.023]. Compared with those before exchange transfusion, the WBC count, PLT count, power of hydrogen (pH) value, HCO3- level, and serum sodium, serum potassium, serum calcium and serum ALB levels were significantly reduced, while RBC count, PT, APTT and blood glucose level were significantly increased after exchange transfusion. The hemoglobin (Hb) level, PaO2 and PaCO2 in the two groups after exchange transfusion showed no statistically significant differences from those before exchange transfusion (P>0.05). After exchange transfusion, double volume group exhibited a significantly decreased PLT count and a significantly raised blood glucose level in contrast with single volume group (P=0.019), and there were no statistically significant differences in the other indicators between the two groups (P>0.05). The exchange transfusion-related adverse reactions mainly included hyperglycemia, acid-base and electrolyte disorders, apnea, necrotizing enterocolitis (NEC) and heart failure. The newborns were all improved and discharged after symptomatic therapy. No statistically significant difference was found in the incidence rate of adverse reactions between the two groups (P>0.05).
Conclusions: For neonatal HB, single-volume exchange transfusion has fewer effects on the internal environment of newborns, needs smaller blood consumption volume and shorter exchange time and can visibly lower the serum bilirubin level in comparison with double-volume exchange transfusion. Therefore, single-volume exchange transfusion has favorable value in clinical application.
References
1. Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Brit J Hosp Med 2017; 78(12): 699-704.
2. Amegan-Aho KH, Segbefia CI, Glover N, Ansa GA, Afaa TJ. Neonatal Jaundice: awareness, perception and preventive practices in expectant mothers. Ghana Med J 2019; 53(4): 267-72.
3. Ebbesen F, Hansen T, Maisels MJ. Update on Phototherapy in Jaundiced Neonates. Curr Pediatr Rev 2017; 13(3): 176-80.
4. Kakkar B, Agrawal S, Chowdhry M, Muthukumaravel PJ, Makroo RN, Thakur UK. Exchange transfusion in neonatal hyperbilirubinemia: A single Centre experience from Northern India. Transfus Apher Sci 2019; 58(6): 102655.
5. Abdel AR, El-Mazary AM, Saidii AA. Can Exchange Transfusion Normalize Serum Levels of Copper, Zinc, and Magnesium in Severe Neonatal Hyperbilirubinemia? J Pediat Hematol Onc 2018; 40(2): e121-6.
6. Thayyil S, Milligan DW. Single versus double volume exchange transfusion in jaundiced newborn infants. Cochrane Db Syst Rev 2006; D4592.
7. Abbas W, Attia NI, Hassanein SM. Two-stage single-volume exchange transfusion in severe hemolytic disease of the newborn. J Matern-Fetal Neo M 2012; 25(7): 1080-3.
8. Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol 2011; 35(3): 175-84.
9. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114(1): 297-316.
10. Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr-Us 2013; 162(3): 477-82.
11. Olusanya BO, Kaplan M, Hansen T. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolesc 2018; 2(8): 610-20.
12. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician 2014; 89(11): 873-8.
13. Xu J, Weng M, Li N, Wu X, Gao L, Yao H, et al. Relationship research between auditory neuropathy spectrum disorder and exchange transfusion in neonates with severe hyperbilirubinemia. Int J Pediatr Otorhi 2019; 123: 146-50.
14. Durante PP, Krebs VL, Brunow DCW. Severe Hyperbilirubinemia in Exchange Transfusion: Less Indication and Lower Mortality. Pediatr Crit Care Me 2016; 17(7): 705.
15. Bhutani VK, Meng NF, Knauer Y, Danielsen BH, Wong RJ, Stevenson DK, et al. Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012. J Perinatol 2016; 36(10): 853-7.
16. Samanta S, Kumar P, Kishore SS, Garewal G, Narang A. Donor blood glucose 6-phosphate dehydrogenase deficiency reduces the efficacy of exchange transfusion in neonatal hyperbilirubinemia. Pediatrics 2009; 123(1): e96-100.
17. Hakan N, Zenciroglu A, Aydin M, Okumus N, Dursun A, Dilli D. Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey. J Matern-Fetal Neo M 2015; 28(13): 1537-41.
18. Chitty HE, Ziegler N, Savoia H, Doyle LW, Fox LM. Neonatal exchange transfusions in the 21st century: a single hospital study. J Paediatr Child H 2013; 49(10): 825-32.
19. Weng YH, Chiu YW. Spectrum and outcome analysis of marked neonatal hyperbilirubinemia with blood group incompatibility. Chang Gung Med J 2009; 32(4): 400-8.
20. Pugni L, Ronchi A, Bizzarri B, Consonni D, Pietrasanta C, Ghirardi B, et al. Exchange Transfusion in the Treatment of Neonatal Septic Shock: A Ten-Year Experience in a Neonatal Intensive Care Unit. Int J Mol Sci 2016; 17(5):
21. Behjati S, Sagheb S, Aryasepehr S, Yaghmai B. Adverse events associated with neonatal exchange transfusion for hyperbilirubinemia. Indian J Pediatr 2009; 76(1): 83-5.
Copyright (c) 2023 Zhongzheng Xiong, Xianchuan Liu, Xiangzhu Li
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.