A clinical study on the effects of exchange transfusion and intensive phototherapy on neurodevelopment in neonates with severe hyperbilirubinemia

Abstract

Objective To study the effects of exchange transfusion(ET) and intensive phototherapy (IPT) on neurodevelopment in neonates with severe hyperbilirubinemia reaching ET criteria. Method From January 2015 to March 2016, neonates with severe hyperbilirubinemia reaching ET criteria with gestational age ≥35 weeks, and hospitalized in the Department of Neonatology of our hospital were enrolled in the study. The parents were informed of the risks of acute bilirubin encephalopathy (ABE) and both the advantages and disadvantages of IPT and ET. Based on the different choices of their parents, the neonates were assigned into the ET group and the IPT group. General conditions, treatment effects, the incidences of ABE and the prognosis were recorded and analyzed. Result A total of 335 patients were included in this study, 147 in the ET group and 188 in the IPT group. Before intervention,the peak of total serum bilirubin (TSB) in ET group (475.8±100.6 μmol/L) was higher than IPT group (398.3±39.8 μmol/L) (the difference of TSB between two groups was 77.4 μmol/L, P 0.05) . No deaths were observed in both groups. Conclusion In neonates with severe hyperbilirubinemia whose TSB exceeding the upper limit of current ET criteria (and within upper limit+5 mg/dl), if the neonates have no risk factors nor clinical symptoms of moderate or severe ABE, only IPT and without ET does not increase the incidence of unfavourable prognosis of central nervous system. Key words: Hyperbilirubinemia, neonatal; Intensive phototherapy; Exchange transfusion; Acute bilirubin encephalopathy; Prognosis