Necessity of conventional calcium supplement in peripheral arteriovenous synchronous blood exchange transfusion on neonatal severe hyperbilirubinemia

Abstract

Objective To explore the necessity of conventional calcium supplement in peripheral arteriovenous synchronous blood exchange transfusion on neonatal severe hyperbilirubinemia. Methods A total of 171 cases of infants with neonatal severe hyperbilirubinemia who needed to receive blood exchange transfusion were selected as research subjects from December 1, 2014 to November 30, 2015 in West China Second University Hospital, Sichuan University. And 86 cases of infants with neonatal severe hyperbilirubinemia who received conventional calcium supplement in peripheral arteriovenous synchronous blood exchange transfusion from December 1, 2014 to April 30, 2015 were enrolled into study group (n=86), while 85 cases of infants who did not received any calcium supplement in peripheral arteriovenous synchronous blood exchange transfusion from May 1, 2015 to November 30, 2015 were enrolled into control group (n=85). The total serum calcium concentrations before and after blood exchange, the incidence rates of hypocalcemia, hypercalcemia and abnormal serum calcium concentration of two groups were statistically compared. Adverse reactions related with calcium in study group were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital, Sichuan University. Informed consents were signed with the guardians of each child. Results ①There were no statistical differences between two groups in the gender ratio, constituent ratio of premature infants and term infants, gestational age, birth weight, age of infants, serum total calcium concentrations before blood exchange transfusion and so on (P>0.05). ②For study group, the serum total calcium concentrations before and after blood exchange transfusion were (2.27±0.26) mmol/L and (2.51±0.33) mmol/L, respectively, and the difference was statistically significant (t=-8.518, P<0.001). For control group, the serum total calcium concentrations before and after blood exchange transfusion were (2.33±0.35) mmol/L and (2.09±0.37) mmol/L, respectively, and the difference also was statistically significant (t=5.268, P<0.001). After blood exchange transfusion, the serum total calcium concentration in study group was higher than that in control group, and the difference was statistically significant (t=-7.894, P<0.001). ③There was no statistical difference between two groups in the incidence rates of abnormal serum calcium concentration (11.8% vs 11.6%, χ2=0.001, P=0.975). The incidence rate of hypocalcemia in study group was 2.3% (2/86), which was lower than that of 11.8% (10/85) in control group, and the difference was statistically significant (χ2=5.837, P=0.016). The incidence rate of hypercalcemia in study group was 9.3% (8/86), which was higher than that of 0 in control group, and the difference was statistically significant (χ2=6.340, P=0.012). ④In study group, 8 cases (9.3%, 8/86) of infants had bradycardia during intravenous injection of calcium supplementation in peripheral arteriovenous blood exchange transfusion therapy, and the symptom recovered when injection was stopped; after intravenous injection of calcium supplementation, 3 cases (3.5%, 3/86) had local skin redness, 1 case (1.2%, 1/86) had localized skin swelling. There was no hypercalcemic crisis occured in study group. Conclusions The calcium supplement cannot completely prevent the occurrence of hypocalcemia in peripheral arteriovenous synchronous blood exchange transfusion for infants with severe neonatal hyperbilirubinemia, but increases the risks of calcium leakage and hypercalcemia. Therefore, the necessity of conventional calcium supplement during the process of blood exchange transfusion therapy needs to be further confirmed by more studies in the future. Key words: Hyperbilirubinemia, neonatal; Peripheral arteriovenous synchronous blood exchange transfusion; Serum calcium; Hypocalcemia; Hypercalcemia; Infant, newborn