Analysis of short-term clinical outcomes in 98 newborns with severe hyperbilirubinemia treated by peripheral arteriovenous synchronous exchange transfusion

Abstract

Objective To study the type of disease, the optimal time and clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia. Methods The clinical data of admitted neonates with severe hyperbilirubinemia who received peripheral arteriovenous synchronous exchange transfusion were retrospectively analyzed from January 2015 to December 2016. Results Ninety-eight neonates were enrolled and the mean gestational age was(38.7±1.2)weeks, the mean birth weight was(3 275.1±483.7) grams, 76 cases were term infants, 20 cases were preterm infants and 2 cases were post term infants.The causes of hyperbilirubinemia included 39 cases of ABO incompatibility(39.8%), 16 cases of Rh incompatibility(16.3%), 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 hyperbilirubinemia(34.7%). The mean age of exchange transfusion was(5.8±4.4)days.Exchange transfusion removed 45.0% of total body bilirubin.After exchange transfusion, the total serum bilirubin, platelet level decreased as compared with those of pre-exchange levels, the differences were statistically significant(t=15.85, P<0.05; t=13.75, P<0.05). The white blood cell counts and hemoglobin increased, the differences were statistically significant(t=4.06, P<0.05; t=4.41, P<0.05). A total of 44 cases who had bilirubin encephalopathy were compared to other 54 cases who didn′t have bilirubin encephalopathy, there were no significant differences in fetal age, age of onset, bilirubin before and after blood exchange.There were significantly differences at time of exchange transfusion and the grade of hospital which the patient admitted at first time(t=2.46, P<0.05; t=6.15, P<0.05). Conclusion Hemorrhagic disease is the most important cause of neonatal severe hyperbilirubinemia.Clinical effect of peripheral arteriovenous synchronous exchange transfusion in the treatment of newborns with hyperbilirubinemia is obvious.Timely exchange transfusion can reduce the occurrence of bilirubinencephalopathy.For basic-level hospitals, it is still necessary to strengthen the implementation of hour-specific bilirubin to predict the risk of neonatal hyperbilirubinemia. Key words: Peripheral arteriovenous synchronous exchange transfusion; Hyperbilirubinemia; Bilirubin encephalopathy; Newborn