Exchange Transfusion Group Research Articles

The Q-oTc and Q-Tc interval and ionized calcium in newborns.

Ionized calcium (CaF), Q-oTc and Q-Tc intervals were determined in 31 full-term healthy newborns, 12 infants subjected to blood exchange transfusion (ET) and 10 infants with verified clinical hypocalcaemia. There was no significant correlation between CaF values and QT intervals. The large fluctuations in CaF during ET did not correspond to any similar change in Q-oTc or Q-Tc intervals. The Q-oTc interval was slightly longer in the hypocalcaemic and the blood exchanged groups compared to controls. The Q-Tc interval was somewhat longer in the ET group. The differences in mean values for QT intervals were fairly small and the ranges wide. ECG findings lack practical implications in diagnosing and following neonatal hypocalcaemia and we therefore recommend the measurement of CaF as a guideline.

Effect of blood exchange transfusion as an initial treatment of acute hemorrhagic pancreatitis.

The effect of blood exchange transfusion on experimental acute pancreatitis was investigated. Acute hemorrhagic pancreatitis was induced in rats by the injection of sodium taurocholate into the pancreatic duct. One hour after the induction of pancreatitis, blood exchange transfusion was carried out in these rats. The survival rates by 24 hr significantly increased in the exchange transfusion group as compared to those in the non-treated control group. Blood exchange transfusion, though had not significant effect on the macroscopic findings at autopsy, reduced pulmonary edema. These results suggested that blood purification by exchange transfusion may be beneficial for patients with acute pancreatitis, especially at an early stage.

The management of polycythaemia in the newborn infant

The management of polycythaemia with hyperviscosity in newborn babies who are clinically well, or who only have minor signs, is not clear. Forty-nine such babies were randomly divided so that 24 were given a partial plasma exchange transfustion and the others were left hyperviscous. The babies were compared with normal controls. Clinical signs were more frequent in exchanged babies, and one developed necrotizing entercolitis. Of the hyperviscous babies 41% had plethoric lungs, 12% abnormal electrocardiograms, 9% were hypocalcaemic and 30% hypomagnesaemic. Behavioural testing after birth revealed differences in both groups when compared with controls. There were more poor scores in the exchange transfusion group. Neurological examination did not reveal marked differences among the groups. Developmental and neurological achievement at 8 mth of age was normal in all the babies. In the present study it is suggested that newborn babies with hyperviscosity who are clinically well or who only have minor signs do not necessarily benefit from partial plasma exchange transfusion.

A Study on Hyperviscosity in Neonatal period

In the management of the new born, the so-called hyperviscosity syndrome is becoming problematic and in the high hematocrit group of over 65% circulatory obstruction and cyanose appear. We recognized symptoms of hypercoagulability namely an increase of fibrinogen and SFMC (soluble fibrin monomer complex) and followed the changes of coagulation fibrinolysis system after heparin therapy and partial exchange transfusion.Method In 20 cases of newborn with a 65% or over hematocrit value and an increase in SFMC, 10 cases were treated with heparin and 10 cases were given partial exchange transfusion with fresh frozen plasma. Measurement on the following were made: (i) fibrinogen volume, (ii) SFMC, (iii) platelet aggregation (iv) PT. PTT, (v) TEG, (vi) antithrombin III, (vii) erythrocytoblast, (viii) ELT, , and (ix) FDP.Results In the partial exchange transfusion group, in 3 cases which showed hematocrit values of over 75%, a remarkable increase in erythrocytoblast, and a strong hemolysis and a high anemia was seen. Partial exchange transfusion was done but a sudden shortening of ELT was seen during operation. Post operatively with a lowering of SFMC and hematocrit values improvement of clinical signs were seen.In the heparin treated group, as a result of a 100-150 units/kg heparin injection a decrease in SFMC was seen and antithrombin III showed a 60% decrease of that prior to treatment.

The Short Follow up Studies for Newborn after Serious Jaundice

Clinical examinations were done in 6 Hospital on 206 infants.We observed 160 infants in which 131 (81.9%) had exchange transfusion and others 29 (18.1%) had non-exchange transfusion.In exchange transfusion group, 18 typical cerebral palsy (c. p.) was found (13.7%).In non-exchange transfusion group 1 typical c. p. was found. (non-typical or questionable type was avoided.)Typical c. p. in 160 infants after jaundice were 19 infants (12%).In our studies hyperbilirubinemia on typical c. p. showed over 25mg/dl, but 10 infants over 30mg/dl Bilirubinemia was no c. p. and under 20mg/dl Bilirubinemia a few c. p. was seen.So the exchange transfusion showld be done according to hyperbilirubinemia and clinical findings (conf. Praah' Stadium).From standpoint of orthopedist we hope that the early diatnosis and treatment of c. p. must be done with co-work by pediatrists, obstetricians and orthopedists.

STUDIES OF NON-HEMOLYTIC HYPERBILIRUBINEMIA IN PREMATURE INFANTS

1. A prospective clinical study of nonhemolytic hyperbilirubinemia in premature infants included 187 infants, of whom 100 had hyperbilirubinemia above 18 mg/100 ml and 87 had bilirubin levels never in excess of 15 mg/100 ml. In a random fashion, the infants with hyperbilirubinemia were divided evenly and either received replacement transfusions or did not. 2. Of the 50 infants in the exchange transfusion group, bilirubin levels were adequately controlled in 48 infants. There was no mortality associated with the exchange transfusion procedure. After 1 year, there does not appear to be any definite evidence of kernicterus in this group. 3. In the no-exchange group, 10 of the 50 infants had levels of bilirubin over 24 mg/ 100 ml for more than 48 hours. Of these, 1 developed fatal kernicterus. Eight of the other 9 infants, whose bilirubin values exceeded 24 mg/100 ml, and 32 of the original 40, whose bilirubin levels were over 18 but below 24 mg/100 ml, were examined neurologically after 1 year. No evidence of kernicterus was found. 4. Seventy-five of the 87 control infants were also examined neurologically after 1 year and none had evidence of kernicterus. 5. The evidence to date suggests that exchange transfusions in the management of non-hemolytic hyperbilirubinemia of the premature not associated with clinical factors which may enhance the development of kernicterus such as asphyxia, hypoproteinemia, sepsis, etc., need not be performed for unconjugated bilirubin values under 24 mg/100 ml. We believe that infants who will develop bilirubin levels in excess of 24 mg/100 ml may be anticipated if their plasma values exceed 20 mg/100 ml between 73 to 96 hours of age or 22 mg/100 ml between 96 and 120 hours. 6. The validity of these conclusions is dependent upon the long-term follow-up of these infants.