The Impact of Treatment Options on Neurodevelopmental Status of Neonates with Jaundice Requiring Exchange Transfusion
PDF
Cite
Share
Request
Original Article
VOLUME: 19 ISSUE: 2
P: 151 - 161
August 2021

The Impact of Treatment Options on Neurodevelopmental Status of Neonates with Jaundice Requiring Exchange Transfusion

J Curr Pediatr 2021;19(2):151-161
1. Ankara Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Ankara, Türkiye
2. Ankara Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Neonatoloji Bilim Dalı, Ankara, Türkiye
3. Ankara Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Gelişimsel Pediatri Bilim Dalı, Ankara, Türkiye
4. Sakarya Üniversitesi Tıp Fakültesi, Halk Sağlığı Anabilim Dalı, Sakarya, Türkiye
No information available.
No information available
Received Date: 25.03.2021
Accepted Date: 14.06.2021
Publish Date: 25.08.2021
PDF
Cite
Share
Request

ABSTRACT

Conclusions:

Admission bilirubin level and the ratio of bilirubin to albumin was among the factors that increase the risk of exchange transfusion. Late admission with significant hyperbiluribinemia may be prevented by identification of neonates at risk for developing significant hyperbilirubinemia before discharge or early in follow-up.

Results:

Exchange transfusion was performed in 19 (18.3%) patients. Main factors that increase the risk of exchange transfusion were bilirubin level and bilirubin/albumin ratio. Cut-off bilirubin level and bilirubin/albumin ratio which increase the risk for exchage transfusion were 26.43mg/dl and 7.43mg/g respectively.

The underlying etiologies were hemolytic disease (29.8%), dehydration and breast milk jaundice (28.8%), prematurity (26.9%). Late comers (postnatal >96 hours) were more likely to have bilirubin level ≥25 mg/dl. Development delays were detected in 13.8% of 65 cases.

Materials and Methods:

Newborns who were admitted with bilirubin levels above the excahge transfusion thresholds (American Academy of Pediatrics, guideline 2004) total 104 cases were enrolled to the study. A total of 65 cases at 12-36 months were evaluated with Guide for Monitoring Child Development. The clinical and demographic characteristics, risk factors, treatment modalities, etiology of the groups and long-term neurodevelopmental status were compared between the groups with and without exchange transfusion,

Introduction:

Though predicting the emerging hyperbiluribinemia is the rational approach, timely exchange transfusion in significant neonatal hyperbilirubinemia is vital.

The aim of this study is to evaluate the socio-demographic and clinical characteristics of newborns with significant hyperbilirubinemia, to evaluate risk factors for exchange transfusion and long-term neurodevelopmental status.

Keywords:
Hyperbilirubinemia, exchange transfusion, jaundice, newborn

References

1
Zipursky A, Bhutani VK. Impact of of Rhesus disease on the global problem bilirubin-induced neurologic dysfunction. Semin Fetal Neonatal Med 2015;20:2-5.
2
Kliegman R, Stanton B, Geme JS, (eds). Nelson Textbook of Pediatrics, 21rd edition. Phialdelphia, PA: Elsevier;2019.
3
Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 2013;74(Supp 1):86-100.
4
Slusher TM, Zamora TG, Appiah D, Stanke JU, Strand MA, Lee BW, et al. Burden of severe neonatal jaundice: a systematic review and meta-analysis. BMJ Pediatr Open 2017;1:e000105.
5
Olusanya BO, Osibanjo FB, Mabogunje CA, Slusher TM, Olowe SA. The burden and management of neonatal jaundice in Nigeria: A scoping review of the literature. Niger J Clin Pract 2016;19:1-17.
6
Greco C, Arnolda G, Boo NY, Iskander IF, Okolo AA, Rohsiswatmo R, et al. Neonatal Jaundice in Low- and Middle-Income Countries: Lessons and Future Directions from the 2015 Don Ostrow Trieste Yellow Retreat. Neonatology 2016;110:172-80.
7
Erdeve O, Okulu E, Olukman O, Ulubas D, Buyukkale G, Narter F, et al. The Turkish Neonatal Jaundice Online Registry: A national root cause analysis. PLoS One 2018;13:e0193108.
8
Bhutani VK, Johnson-Hamerman L. The clinical syndrome of bilirubin-induced neurologic dysfunction. Semin Fetal Neonatal Med 2015;20:6-13.
9
Çoban A, Kaynak Türkmen M, Gürsoy T. Türk neonatoloji derneği yenidoğan sarılıklarında yaklaşım, izlem ve tedavi rehberi. Türk Pediatri Ars. 2018;53(Suppl 1):172-9.
10
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.
11
Wiedmeier SE, Bahr TM, Ohls RK, Christensen TR, Baer VL, Ilstrup SJ, et al. Exchange transfusion for hemolytic hyperbilirubinemia: could some be averted by emergent administration of an inhibitor of bilirubin production? J Perinatol 2021;41:860-4.
12
Ip S, Chung M, Kulig J, O’Brien R, Sege R, Glicken S, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004;114:130-53.
13
Besli GE, Metin F, Aksit MA, Saltik S. Long-term Effects of Indirect Hyperbilirubinemia on Auditory and Neurological Functions in Term Newborns. Medeni Med J 2020;35:29-39.
14
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;36:853-7.
15
Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ 2006;175:587-90.
16
Sgro M, Kandasamy S, Shah V, Ofner M, Campbell D. Severe Neonatal Hyperbilirubinemia Decreased after the 2007 Canadian Guidelines. J Pediatrics 2016;171:43-7.
17
Ertem IO, Dogan GD, Gok CG, Kizilates SU, Caliskan A, Atay G, et al. A Guide for Monitoring Child Development in Low and Middle-Income Countries. Pediatrics 2008;121:581-9.
18
Ertem IO, Krishnamurthy V, Mulaudzi MC, Sguassero Y, Balta H, Gulumser O, et al. Similarities and differences in child development from birth to age 3 years by sex and across four countries: a cross-sectional, observational study. Lancet Glob Health 2018;6:279-91.
19
Ertem IO, Krishnamurthy V, Mulaudzi MC, Sguassero Y, Bilik B, Srinivasan R, et al. Validation of the International Guide for Monitoring Child Development demonstrates good sensitivity and specificity in four diverse countries. Acta Paediatr 2019;108:1074-86.
20
Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med 2000;154:1140-7.
21
Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, Boerma T, et al. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries. BMJ 2018;360:k55.
22
Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Türkiye Nüfus ve Sağlık Araştırması, 2008. TC Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye.
23
Davidson L, Thilo EH. How to Make Kernicterus a “Never Event”. NeoReviews 2003;4:308-14.
24
Iskander I, Gamaleldin R, El Houchi S, El Shenawy A, Seoud I, El Gharbawi N, et al. Serum bilirubin and bilirubin/albumin ratio as predictors of bilirubin encephalopathy. Pediatrics 2014;134:1330-9.
25
Hulzebos CV, Dijk PH. Bilirubin-albumin binding, bilirubin/albumin ratios, and free bilirubin levels: Where do we stand? Semin Perinatol 2014;38:412-21.
26
Ardakani SB, Dana VG, Ziaee V, Ashtiani MTH, Djavid GE, Alijani M. Bilirubin/Albumin Ratio for Predicting Acute Bilirubin-induced Neurologic Dysfunction. Iran J Pediatr 2011;21:28-32.
27
Yu C, Li H, Zhang Q, He H, Chen X, Hua Z. Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in Southwestern China during an 11-year period, from 2001 to 2011. PLoS One 2017;12:e0179550.
28
Christensen RD, Baer VL, MacQueen BC, O’Brien EA, Ilstrup SJ. ABO hemolytic disease of the fetus and newborn: thirteen years of data after implementing a universal bilirubin screening and management program. J Perinatol 2018;38:517-25.
29
Bülbül A, Okan FF, Ünsür EK, Nuhoğlu A. Adverse events associated with exchange transfusion and etiology of severe hyperbilirubinemia in near-term and term newborns. Turk J Med Sci 2011;41:93-100.
30
ElTatawy SS, Elmazzakhy EA, El Shennawy AM, Madani HA, Youssef HA, Iskander IF. The spectrum of bilirubin neurotoxicity in term and near-term babies with hyperbilirubinemia: Does outcome improve with time? Early Hum Dev 2019;140:104909.
31
Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006;354:1889-900.
32
Olusanya BO, Osibanjo FB, Slusher TM. Risk Factors for Severe Neonatal Hyperbilirubinemia in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. PLoS One 2015;10:e0117229.
33
Harris MC, Bernbaum JC, Polin JR, Zimmerman R, Polin RA. Developmental Follow-Up of Breastfed Term and Near-Term Infants With Marked Hyperbilirubinemia. Pediatrics 2001;107:1075-80.
34
Wong V, Chen WX, Wong KY. Short and long-term outcome of severe neonatal nonhemolytic hyperbilirubinemia. J Child Neurol 2006;21:309-15.
35
Duman N, Ozkan H, Serbetcioglu B, Ogun B, Kumral A, Avci M. Long-term follow-up of otherwise healthy term infants with marked hyperbilirubinaemia: should the limits of exchange transfusion be changed in Turkey? Acta Paediatr 2004;93:361-7.
36
Newman TB, Liljestrand P, Escobar GJ. Infants With Bilirubin Levels of 30 mg/dL or More in a Large Managed Care Organization. Pediatrics 2003;111:1303-11.