Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia

Abstract

In a recent study, Lu et al. reported the results of fully automated simultaneous peripheral arteriovenous exchange transfusion (ET) on brain function and internal environment in neonates with severe hyperbilirubinemia.1Lu W.N. Yang X.Y. Ning S.Y. Chen Z.G. Pan S.N. Fully automated simultaneous peripheral arteriovenous exchange transfusion not seen to aggravate brain function and the disorder of the internal environment in neonates with severe hyperbilirubinemia.Pediatr Neonatol. 2021; 62: 312-320Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In this study involving 39 neonates with hyperbilirubinemia, findings were made that automated simultaneous peripheral arteriovenous ET therapy could significantly reduce the concentration of direct bilirubin (DB) and total bilirubin (TB), and had no significant effect on the internal environment and neurological function. The authors undoubtedly made great efforts and provided novel insights for the treatment of neonates with hyperbilirubinemia. However, several significant factors related to the conclusion of this study need to be addressed. From the description of this study, it is made clear that this is a paired pre-post study.2Meda I.B. Kouanda S. Dumont A. Ridde V. Effect of a prospective payment method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study.Health Policy Plan. 2020; 35: 775-783Crossref PubMed Scopus (3) Google Scholar The authors compared the differences of related parameters (such as DB, TB, lactate and glucose) before and after automated simultaneous peripheral arteriovenous ET treatment. Despite ET being a common treatment for neonates with hyperbilirubinemia, the use of other strategies could also affect the concentration of TB and DB. For example, previous studies have evidenced that infant massage,3Lin C.H. Yang H.C. Cheng C.S. Yen C.E. Effects of infant massage on jaundiced neonates undergoing phototherapy.Ital J Pediatr. 2015; 41: 94Crossref PubMed Scopus (28) Google Scholar phototherapy4Ebbesen F. Hansen T.W.R. Maisels M.J. Update on phototherapy in jaundiced neonates.Curr Pediatr Rev. 2017; 13: 176-180Crossref PubMed Scopus (12) Google Scholar and ursodeoxycholic acid5Honar N. Ghashghaei Saadi E. Saki F. Pishva N. Shakibazad N. Hosseini Teshnizi S. Effect of ursodeoxycholic acid on indirect hyperbilirubinemia in neonates treated with phototherapy.J Pediatr Gastroenterol Nutr. 2016; 62: 97-100Crossref PubMed Scopus (8) Google Scholar significantly reduce the concentration of TB and DB. Thus, the decrease of TB and DB may not be caused by automated simultaneous peripheral arteriovenous ET treatment, but might be caused by other drugs or treatment strategies. In this study, the authors did not describe the detailed treatment of the included neonates. It is unclear whether the included neonates received any other treatment in addition to automated simultaneous peripheral arteriovenous ET therapy, and whether these treatments affected the concentration of TB, DB and other parameters. Considering that other treatment measures may have a significant impact on the conclusion of this study, further clarification is needed on whether automated simultaneous peripheral arteriovenous ET therapy can reduce dB and TB levels in neonates with severe hyperbilirubinemia. None.