Exchange transfusion in initial phase of acute encephalopathy bilirubin of a 7-day old neonate: a case report

Abstract

Hyperbilirubinemia is a common problem in neonatal period, occurring in 60-70% of term and 80% of preterm infants in the first week of life. The elevation of free unconjugated bilirubin can enter the central nervous system which is noxious to neuron and increase the risk of acute bilirubin encephalopathy (ABE). Risk factors of encephalopathy bilirubin or kernicterus with hemolytic disease such as ABO or Rhesus haemolytic disease, G6PD deficiency. The incidence of ABE is about 0.9/100 000. Clinically bilirubin encephalopathy can be devided into 2 phase, acute and chronic phase. The initial of acute phase is noted by lethargy, hypotonia, decreased movement and poor suck, the symptoms will get worsen if the baby doesn’t get adequte therapy. The main of management ABE is exchange transfusion and continues phototherapy to reduce bilirubin level and prevent further hemolysis.We report a case of exchange transfusion in initial phase of acute encephalopathy bilirubin in a 7-day old neonate with ABO incompatibility, whom had icterus since the first day of life. Other complaints are poor feeding, lethargy and hoarsness of cry since one day before admitted to hospital. He was born from mother with O blood type and positive rhesus. The patient had B blood type with positive rhesus, coomb test was positive and the total bilirubin was 41.49 mg/dL, direct bilirubin was 2.8 mg/dl and indirect bilirubin was 38.69 mg/dL. The patient was treated with exchange transfusion, intensive phototherapy. Â