Abstract
Background: Exchange transfusion(ET) has remained the gold standard for rapid lowering of higher bilirubin levels, it is not risk free and mortality rate vary from 0.5 to 3.3%. The present study was carried out to study hemodynamic parameters changes during ET in neonates. Materials and Methods: 22 neonates who suffered from hyperbilirubinemia and required double volume ET were enrolled in this prospective study. ET was carried out according to standard practice guidelines. Clinical hemodynamic parameters including heart rate, respiratory rate, blood pressure, temperature and ECG, % saturation of oxygen (SpO2) and CVP were monitored continuously before 15 min (pre exchange) during 60-120 min(mid exchange) and after 30 min(post exchange). All data was analysed statistically. Results: There was significant increase in mean heart rate152.78(19.88),155.12(20.50), mean respiratory rate 46.02(8.87),50.92(6.98) and drop in mean Spo2 91.19(4.17),90.67(4.28) in mid-exchange and post-exchange values respectively as compared to pre exchange values138.72(17.74),36.79(7.58),93.51(3.28) for mean heart rate, respiratory rate and mean SpO2 respectively. There was significant increase in mean diastolic blood pressure values in post-exchange 45.43(13.88) as compared to pre exchange values 41.83(9.80). Mid-exchange value 8.66(2.12) of mean central venous pressure was significantly lower from pre-exchange 10.10(1.92) and post-exchange 9.56(1.98) values. ECG changes did not show any significant changes during ET. Conclusion: There were significant adverse effects on all hemodynamic clinical parameters. Monitoring of neonate is essential during ET which will prevent complications of ET. Current recommendations for performing ET are based on balance between the risk of encephalopathy and the adverse events related to the procedure holds true.
Highlights
Jaundice is most common and one of the most vexing problems for a pediatrician that can occur in neonate
All newborn infants are born with hyperbilirubinemia which is defined as total serum bilirubin (TSB) of 2mg/dl or more [1]
Neonates suffering from hyperbilirubinemia, who required Exchange transfusion (ET) were enrolled after informed consent from parents
Summary
Jaundice is most common and one of the most vexing problems for a pediatrician that can occur in neonate. About 60% of term and 80% of preterm infants have clinical jaundice in the first week after birth but only 0.02 to 0.16 of them develop severe hyperbilirubinemia (TSB >25mg/dl),which is an emergancy because it may cause neonatal bilirubin encephalopathy which can result in death or irreversible. Exchange transfusion(ET) has remained the gold standard for rapid lowering of higher bilirubin levels, it is not risk free and mortality rate vary from 0.5 to 3.3%. Clinical hemodynamic parameters including heart rate, respiratory rate, blood pressure, temperature and ECG, % saturation of oxygen (SpO2) and CVP were monitored continuously before 15 min (pre exchange) during 60-120 min(mid exchange) and after 30 min(post exchange). Mid-exchange value 8.66(2.12) of mean central venous pressure was significantly lower from pre-exchange 10.10(1.92) and post-exchange 9.56(1.98) values. Current recommendations for performing ET are based on balance between the risk of encephalopathy and the adverse events related to the procedure holds true
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