Need For Exchange Transfusion Research Articles

Efficacy and safety of fenofibrate in combination with phototherapy for the treatment of neonatal hyperbilirubinemia: a systematic review and meta-analyses.

Phototherapy is the standard treatment for neonatal jaundice. We aimed to review the efficacy and safety of fenofibrate as an adjunct therapy. Twelve databases were searched and a systematic review and meta-analysis were conducted. Mean change (MC), mean difference (MD), and risk ratios (RR) with a 95% confidence interval (CI) were calculated using a random effects model. The GRADE approach was used to evaluate the evidence's certainty. Nine randomized trials were included. The MC of total serum bilirubin (mg/dL) was significant at 12, 24, 36, 48, and 72 h with respective MC (95% CI) values of -0.46 (-0.61, -0.310), -1.10 (-1.68, -0.52), -2.06 (-2.20, -1.91), -2.15 (-2.74, -1.56), and -1.13 (-1.71, -0.55). The FEN+PT group had a shorter duration of phototherapy (MD: -14.36 h; 95% CI: -23.67, -5.06) and a shorter hospital stay (MD: -1.40 days; 95% CI: -2.14, -0.66). There was no significant difference in the risk of complications (RR: 0.89; 95% CI: 0.54, 1.46) or the need for exchange transfusion (RR: 0.58; 95% CI: 0.12, 2.81). The certainty of the evidence was very low for all outcomes. In conclusion, fenofibrate might be a safe adjunct to neonatal phototherapy. Larger randomized controlled trials are needed for the confirmation of these results.

Effect of delayed cord clamping on red blood cell alloimmunization: a retrospective cohort study

Although delayed cord clamping has well-known benefits for preterm and term neonates, it has been inadequately assessed in alloimmunized neonates. This study aimed to evaluate the benefits and risks of delayed cord clamping in alloimmunized neonates. This was a retrospective comparative pre-post cohort study conducted from 2003 to 2018 in a tertiary care center in France. All living singleton neonates whose mothers were followed up for red blood cell alloimmunization during gestation and confirmed at birth (N=224) were included. Neonates were either exposed to immediate (n=125) or delayed cord clamping (n=99). Our main outcome was the time from birth to first exchange transfusions and/or transfusions. Secondary outcomes were hemoglobin level at birth, rate of exchange transfusion, number of postnatal transfusions, maximum bilirubin level, and number of phototherapy hours. Hemoglobin at birth was significantly higher in case of delayed cord clamping (mean difference, 1.7 g/dL; 95% confidence interval, 0.7-2.8). Among infants treated with exchange transfusion or transfusion, the time to initial treatment was higher in case of delayed cord clamping (median difference, 8 days; rate ratio, 1.51; 95% confidence interval, 1.09-2.10). There were no significant differences in the need for exchange transfusion, the number of transfusions, the maximum total bilirubin level, nor the number of phototherapy hours. In the subgroup analysis of neonates needing intrauterine transfusion during pregnancy (ie, severe alloimmunization), neonates had a lower rate of exchange transfusion in case of delayed cord clamping (odds ratio, 0.36; 95% confidence interval, 0.15-0.82). Our results indicate a benefit of delayed cord clamping in alloimmunization, regardless of pathology severity, without increased risk of jaundice.

Effectiveness and safety of prophylactic phototherapy to prevent jaundice in premature newborns: Systematic review and meta-analysis.

To determine the effectiveness and safety of prophylactic phototherapy compared with conventional phototherapy for the prevention of neonatal jaundice. We included clinical trials comparing prophylactic phototherapy to conventional phototherapy to prevent jaundice in premature newborns. We searched Embase, MEDLINE, LILACS, Central, and others. The statistical analysis was performed in RevMan (Review Manager 5.3). Outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to heterogeneity. We reported results in forest plots. Risk of bias was evaluated, and a sensitivity analysis was made. 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five studies evaluated the need for exchange transfusion as the primary outcome RD -0.01, 95% CI [-0.05 to 0.03]. One study evaluated bilirubin encephalopathy RD -0.04, 95% CI [-0.09 to 0.00]. Five studies evaluated the duration of phototherapy, MD 38.47, 95% CI [1.28 to 55.67]. Four studies evaluated levels of bilirubin (MD -1.23, 95% CI [-2.25 to -0.21]. Two studies evaluated mortality, RD 0.01, 95% CI [-0.03 to 0.04]. As a conclusion, compared to conventional phototherapy, prophylactic phototherapy decreases the last measured level of bilirubin, as well as the probability of neurodevelopmental disturbances. However, it increases phototherapy duration.

Evaluate of newborn with jaundice at central teaching hospital of pediatrics in Baghdad : descriptive study

Background: - Neonatal jaundice is a frequent condition at newborns, particularly in the first few days after delivery, and it has to be treated well to prevent complications that might have significant, long-lasting complications.
 Objective: - To assess the outcome of newborn jaundice at the central teaching Hospital of pediatrics in Baghdad using different modality of treatments.
 Patients and Methods: - A retrospective study is done depending on the medical data of infants have jaundice who were admitted to the neonate units of the central teaching hospital within the period of a year, from May 1st 2020 to May 1st 2021. Blood grouping and total serum bilirubin measurements were taken in each case. Phototherapy, strong phototherapy, and exchange transfusion were utilized to treat the newborn jaundice, depending on its severity.
 Results: Total neonates admitted from 1st may2020 to1st may 2021 in neonate unit were 2508 and 855 [34%] have jaundice. the male: female rati0 is [1.6:1], males 516[60.3%], females 339[39.6%]. The Physiol0gical jaundice is the often-frequent cause 285[33.3%] patients. The Prematurity seen in 171[20%] patient and the ABO incompatibility seen in 128[1.3%] and the Rh incompatibility 17[2%] patient, the sepsis found in 16[2%] case and the other causes of hyperbilirubinemia seen in 238[27.8%] patient. the Phototherapy is the most frequent kind of management used in 513[55%] and intensive phototherapy is applied for 342[40.3%] patients and just 59[7%] of patients treated with exchange transfusion particularly patients with ABO incompatibility 25 [42%] also Rh incompatibility 34 [57.6%] Good decline in TSB level and not require the exchange transfusion is 812 [95%] of patients. Majority of infants 849 [99.55%] discharge with clinical improvement and only 17 [0.3%] of infant’s patients develops kernicterus and 8 patients is dying [0.1%]
 Conclusion: Moderate to severe hyperbilirubinemia is still often treated with phototherapy. Intensive phototherapy is beneficial in lowering T.S.B levels, minimizing the need for exchange transfusions, and shortening hospital stays in patients with newborn hyperbilirubinemia.

Role of IVIg in Severe Neonatal Jaundice due to Isoimmunization A Retrospective Cohort Study

Aim To see the efficacy of intravenous immunoglobulin (IVIg) in reducing the need for exchange transfusion (ET) in neonates with isoimmune hemolytic disease with serum bilirubin at or above exchange level. Methods Retrospective cohort study conducted in neonatal intensive care unit of a tertiary care center from March 2015 to February 2020 included neonates with gestational age ≥35 weeks with positive Direct Coombs Test with serum bilirubin at or above exchange level according to American Academy of Pediatrics charts with no bilirubin encephalopathy at presentation. Study subjects were followed till discharge. Results ET was prevented in 8/41 (19.5%) cases who received IVIg initially vs. 2/51 cases (3.92%) who didn’t ( P = .02, relative risk: 1.98 with 95% confidence interval [1.32-2.98] with number needed to treat: 2.51). Total duration of phototherapy was significantly lesser in those receiving IVIg ( P < .0001). Conclusion Targeted use of IVIg in isoimmune hemolytic disease of newborn with serum bilirubin rising despite intensive phototherapy or within 2 to 3 mg/dL of the exchange level is more likely to benefit than harm and remain prudent.

The effect of oral use of concentrated pomegranate juice by mothers on hyperbilirubinemia in neonates under phototherapy: A randomized clinical trial.

Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia. In this open-labeled, add-on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy. Besides neonates' phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes. CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123). Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.

A Rare Case of Lenalidomide Providing Control of Severe Sickle Cell Anemia in a Patient with Coexisting Multiple Myeloma

Background: Multiple myeloma (MM) rarely coexists with Sickle Cell Anemia (Hb-SS-Disease). Whereas MM usually affects those older than 50, Sickle Cell Anemia is a congenital disease with a median life expectancy of 42-47 years. In one recent survey by Zerdan et al (Am J Case reports 2021), there have been 12 cases of coexisting MM with Sickle Cell Disease (including 4 cases of compound sickle cell syndrome). Pareseval et al (J Clin Investigation 2008) has previously shown that the thalidomide analogues Lenalidomide and particularly Pomalidomide are effective inducers of Hgb F in ex-vivo erythroid cells from both healthy donors and patients with SCD. Kutlar et al (Blood 2013) reported on a phase I dose-escalation trial of Pomalidomide given for 12 weeks in patients with SCD, which demonstrated an increase in Hgb F. However, there has not been further progress in exploring this modality of treatment since that time. Here, we report a rare case of a patient with Sickle Cell Anemia who was diagnosed with MM at the age of 38, and is benefiting from Lenalidomide for the treatment of both conditions. Case: 38 y/o M with a history of Sickle Cell Anemia complicated by pulmonary embolism and recurrent deep vein thrombosis, priapism and thrombotic strokes at the ages of 6 and 18 years and follows at hematology clinic for SCD management. Patient was maintained on Hydroxyurea and partial exchange transfusions every 2 weeks with a goal sickle cell hemoglobin (HbS) of 30%. He developed another stroke at the age of 35, and was found to have Moyamoya disease and intracranial bleed which required craniotomy and evacuation. Later, he was incidentally detected to have smoldering multiple myeloma confirmed by bone marrow biopsy which then clinically progressed to MM. He was started on treatment for MM, received a total of 11 cycles of Lenalidomide + Bortezomib + Dexamethasone (RVD regimen) and later transitioned to Lenalidomide alone as maintenance. Around this time, patient was switched to full exchange transfusion, with close monitoring of Hgb S to determine the timing of each exchange. In this context, it was noted that the Hgb F level was steadily rising and peaked at 21% in January 2020, with Hgb S of 41% and transfusion-induced Hgb A of 35%. Once the COVID-19 pandemic set it, the patient stayed at home as a precaution against infection, but the Lenalidomide maintenance was continued, along with Hydroxyurea. He was followed remotely with televisits and home blood draws for the following 2 years. His Hgb F stayed between 25-30% and he had no sickle cell crises and did not require any blood transfusions. He has not had significant side effects from Lenalidomide and the MM has remained controlled, as well. Conclusion: It is interesting to note that our patient with severe Sickle Cell Anemia, with a history of multiple strokes, has had sustained control of his disease for 2 years while on Hydrea and maintenance Lenalidomide (used primarily for prevention of MM relapse), without the need for exchange transfusions. This outcome supports the pre-clinical findings of Parseval et al, and may provide additional basis for advancing clinical research of thalidomide analogues in the management of Sickle Cell Anemia.

Intensive phototherapy as the initial management of severe hyperbilirubinemia in neonates

Hyperbilirubinemia is one of the most common clinical phenomena found in newborns, which is about 60% of term infants and 80% of preterm infants in the first week of life. Severe hyperbilirubinemia can cause encephalopathy and permanent neurodevelopmental damage with an incidence that varies between 4% - 60.3% and mortality rate of 13% to 56.8% worldwide. Phototherapy and exchange transfusion are therapeutic modalities for infants with severe hyperbilirubinemia. Intensive phototherapy has fewer side effects and can reduce the need for exchange transfusion. This treatment is rarely needed if intensive phototherapy is effective, current guidelines for the management of hyperbilirubinemia focus on the use of intensive phototherapy as initial treatment. This literature review aims to discuss intensive phototherapy as the initial management of severe hyperbilirubinemia in neonates.

A comparative study between glucose 6-phosphate dehydrogenase deficient and normal term neonates with indirect hyperbilirubinemia in a rural tertiary care hospital of Eastern India

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an important cause of neonatal indirect hyperbilirubinemia or even kernicterus leading to long-term neurological sequelae specially in countries like India where G6PD deficiency is quite prevalent. Aims and Objectives: We have planned this study to know the prevalence of G6PD deficiency among cases of neonatal jaundice and also to evaluate the difference between G6PD deficient and normal neonates with indirect hyperbilirubinemia in terms of laboratory parameters and need of phototherapy or exchange transfusion. Materials and Methods: This observational and cross-sectional study was done for a period of 1 year in the SNCU and NICU of a district Medical College of West Bengal among 200 term neonates presented with indirect hyperbilirubinemia. Birth weight, sex, hemoglobin, G6PD level, serum bilirubin at admission, phototherapy duration, and need for exchange transfusion were recorded along with other necessary parameters. Results: We found G6PD deficiency in 24 neonates (12%) out of 200 cases of neonatal jaundice, 20 of whom were male. There is a statistically significant difference in hemoglobin and serum bilirubin level between two groups. Difference in early presentation of jaundice within 24–48 h (66.7% vs. 34.1%) and need of prolonged phototherapy 72–96 h (45.83% vs. 7.4%) between G6PD deficient and normal group were statistically significant. Difference in requirement of exchange transfusion is not statistically significant. Conclusion: Early screening for G6PD deficiency should be considered in every neonates of G6PD deficient endemic countries so that we can predict the natural course of the jaundice in those G6PD deficient neonate and prevent complication by early initiation of phototherapy or exchange transfusion.

Validation of an instrument for the evaluation of exchange transfusion (INEXTUS) via an OSCE

IntroductionExchange transfusion is the treatment of choice for patients with severe hyperbilirubinemia who do not respond to phototherapy. This procedure is highly complex and requires substantial expertise to perform, however it´s not done frequently enough to guarantee adequate training. Traditional learning scenarios do not have a space reserved for teaching this procedure or an instrument that fully and objectively evaluates the skills that a professional must acquire. ObjectivesThe purpose was to construct and evaluate the INEXTUS instrument´s validity evidence relevant to internal structure, in a simulated scenario through the performance of an objective structured clinical exam (OSCE). Materials and methodsThe Delphi consensus methodology was utilized to design the instrument; six experts participated through three rounds using the Google Forms platform. The categories and items previously obtained were subjected to validation by nine experts through a dichotomous survey. Prior to data collection, the evaluators were trained through a pilot test with 10 medical students. Subsequently, all residents of a paediatric programme were evaluated through the OSCE methodology in a simulated scenario, with 6 stations, of a clinical case of a new-born with an explicit need for exchange transfusion. During their participation in the scenario, the residents were first evaluated with the instrument developed. Additionally, audio and video filming of all students who participated was performed with the aim of conducting a second evaluation two weeks after the first four evaluators participated.ResultsThe final INEXTUS instrument consists of 46 subitems grouped into 23 items divided into 6 categories, demonstrating an inter-rater intraclass correlation coefficient of 0.96 (95% CI 0.94, 0.98 p-value < 0.001). For the Fleiss Kappa of the 23 items evaluated, concordance was evaluated for 14 items but could not be determined for the 9 remaining items because all the ratings were equal, either because the items were not performed or they were all performed adequately. Of the 14 items, 9 good scores were obtained (95% CI 0.61 to 0.8; p value < 0.001), and 5 very good scores were obtained (95% CI 0.81 to 1; p value < 0.001).ConclusionsThe INEXTUS instrument evaluates exchange transfusion skills in medical personnel in training in simulated scenarios using the OSCE methodology; it has high validity and reliability and is a high-impact educational tool.

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion.

IntroductionIntravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion.Materials and MethodsThis study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared.ResultsDuring the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively).ConclusionIn this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.

International guidelines regarding the role of IVIG in the management of Rh- and ABO-mediated haemolytic disease of the newborn.

Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence‐based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO‐mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody‐mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High‐quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.

Periodic change of body position under phototherapy in term and preterm neonates with hyperbilirubinaemia.

Phototherapy is the mainstay of treatment of neonatal hyperbilirubinaemia. Periodic change in position of the neonate under phototherapy (from supine to prone or lateral positions) may improve the efficiency of phototherapy by hastening the access of phototherapy light to bilirubin deposited in different parts of the skin and subcutaneous tissue. To evaluate the effects of periodic change of body position during phototherapy as compared to no prescribed change in body position, on serum total bilirubin level and duration of treatment in neonates with unconjugated hyperbilirubinaemia during the first 28 days of life. Secondary objectives of the review included evaluation of the efficacy of periodic change of body position on the need for or number of exchange transfusions, incidence of bilirubin-induced neurological damage (BIND), side effects of phototherapy, and sudden infant death syndrome (SIDS). We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 3) in the Cochrane Library and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions on 5 March 2021. We also searched clinical trials databases and the reference lists of included studies and relevant reviews for randomised controlled trials (RCTs) and quasi-RCTs. We included RCTs and quasi-RCTs if they enrolled neonates (term and preterm) of either gender with unconjugated hyperbilirubinaemia requiring phototherapy and compared periodic change of the body position of the infant under phototherapy with no prescribed change in body position. Two review authors independently assessed trial quality and extracted data, consulting with a third review author in the case of disagreement. We used standard Cochrane methodological procedures, including assessing the risk of bias of included studies. We used the GRADE approach to assess the certainty of evidence. Primary outcomes were the duration of phototherapy and rate of fall of serum bilirubin at 24 hours. Secondary outcomes included the need for exchange transfusion, number of exchange transfusions, incidence of BIND, and SIDS. We included five studies (343 neonates) with an overall high risk of bias in the review. The body position under phototherapy was changed every two hours or every two-and-a-half hours in two studies each, and every three hours in one study. Three of the five studiesincluded healthy term neonates, whilst the other two studies also included preterm neonates (≥ 33 weeks' gestation); however, separate data about review outcomes in preterm neonates were not available. Periodic change in body position may lead tolittle or no difference in the duration of phototherapy (mean difference (MD) 1.71 hours, 95% confidence interval (CI) -3.17 to 6.59 hours; I² = 58%; 4 studies, 231 participants; low certainty evidence). Only one study reported the rate of fall of serum total bilirubin at 24 hours of starting the phototherapy. Periodic change in body position may lead tolittle or no difference in the rateof fall of serum total bilirubin at 24 hours(MD0.02 mg/dL/h, 95% CI -0.02 to 0.06 mg/dL/h; 1 study, 100 participants; low certainty evidence). We downgraded the certainty of evidence to low due to risk of bias and imprecision. None of the included studies reported the need for or number of exchange transfusions, incidence of BIND, or SIDS. Lack of separate data precluded subgroup analysis. The available evidence is insufficient to determine the effects of periodic change of body position compared with no prescribed change of body position under phototherapy. There is low certainty evidence that there may be little or no difference in the duration of phototherapy andrate of fall in bilirubin at 24 hours of starting phototherapy between periodic change in body position and no prescribed change of body position under phototherapy in term and preterm neonates. None of the included studies reported the effect of change of position on the need for or number of exchange transfusions, incidence of BIND, or SIDS. One study is awaitingclassification and could not be included in the review. Further studies are needed to evaluate theeffectof periodic change in body position under phototherapy, especially in neonates with haemolytic hyperbilirubinaemia and in very preterm neonates. The results of this systematic review apply mainly to neonates born at late-preterm or term gestation receiving phototherapy for non-haemolytic hyperbilirubinaemia.

Intravenous Fluid Supplementation for Preterm Infants With Hyperbilirubinemia: A Retrospective Cohort Study.

Hyperbilirubinemia is one of the most frequently occurring problems in the neonatal period, and phototherapy has remained the primary treatment of choice. Fluid supplementation has been proposed to reduce serum bilirubin levels. To assess the risks and benefits of fluid supplementation compared with standard fluid management in preterm infants with unconjugated hyperbilirubinemia under conventional phototherapy. A retrospective cohort study of preterm infants (gestational ages ≥28 to ≤32 weeks) admitted to the neonatal intensive care unit at the Maternity and Children Hospital in Jeddah, Saudi Arabia, from January 1, 2017, to December 31, 2017, and required the initiation of phototherapy in the first week of life. One hundred and fifteen infants were included; 51 received fluid supplementation, and 64 received standard fluid management. There were no significant differences in demographic characteristics between groups. The infants who received fluid supplementation had a significantly larger decline in the total serum bilirubin level per day and a shorter phototherapy duration ( P < .01). There were no significant differences in weight ( P = .14), or sodium ( P = .79) change per day or the need for exchange transfusion between groups. The prematurity-related inhospital morbidities were similar between groups. Fluid supplementation in preterm infants receiving conventional phototherapy resulted in a faster decline in the bilirubin level and a shorter duration of phototherapy, without increasing prematurity-related morbidities. Future randomized controlled trials to assess the benefits and risks of fluid supplementation during conventional phototherapy in preterm infants are needed.

Predicting Significant Hyperbilirubinemia in ABO Incompatibility: Is Cord Direct Antiglobulin Test Useful?

To study the prevalence of direct antiglobulin test (DAT) positivity and outcomes in babies with ABO incompatibility and the role of DAT in predicting need for phototherapy. This was an analytical retrospective cohort study conducted in a tertiary care hospital in South India. DAT was performed routinely in cord blood of all neonates born to O positive mothers. The case records of neonates ≥ 35weeks of gestation and birth weight > 2000gm with ABO setting born between January 2019 and December 2020 were reviewed and outcomes were analyzed. Among 2484 live births, there were 426 eligible ABO incompatible births and DAT was positive in 68(15.9%). DAT positive neonates had significantly higher peak mean bilirubin [16.02mg/dL vs. 13.68mg/dL, p = 0.00], need for phototherapy in first 24h [23(33.8%) vs. 32(8.9%), p = 0.00], need for exchange transfusion [2(2.9%) vs. 0(0%), p = 0.025] and immunoglobulin [6(8.8%) vs. 0(0%), p = 0.00]. Cord DAT showed 29.9% sensitivity, 96.9% specificity, 89.7% positive predictive value and 60.1% negative predictive value for predicting need for phototherapy. DAT positivity occurs in a significant proportion of ABO incompatible births and a "selective" cord blood DAT in neonates born to O positive mothers can identify those neonates at risk of significant hyperbilirubinemia with high diagnostic accuracy.

Clinical Profile and Outcome Following Exchange Transfusion for Neonatal Jaundice in a Tertiary Care Centre.

Phototherapy has reduced the need for exchange transfusion (ET) to manage jaundiced neonates. Hence there are concerns about increased risk of complication due to lack of opportunity to sustain skills in performing ET. We studied the complications and treatment outcomes of neonates treated for jaundice with ET. A retrospective observational study was conducted from June 2013 to June 2020 in a tertiary care hospital in India. All neonates treated with ET for jaundice were included. Twenty-eight neonates underwent 31 ET during the study period. Their mean gestational age and birth weight were 37 weeks and 3200 g, respectively. Predisposing factor for jaundice observed were Coomb's positive status (11), hepatosplenomegaly suggesting hemolysis (3), cephalhematoma (2) and birth asphyxia (1). Abnormal neurological status before ET was seen in seven neonates. Adverse clinical events that happened during or within 8 h after ET were desaturation (4), tachycardia (3), tachypnea (2), bradycardia (2), shock (2) and temperature instability (2). One neonate developed acute kidney injury after ET and required peritoneal dialysis. Abnormal lab parameters observed during or within 8 h after ET were hypocalcemia (20), anemia (8), hypokalemia (7), hypernatremia (3), thrombocytopenia (3) and hyperkalemia (2). Post ET sepsis was seen in five neonates: two had only blood culture positive sepsis, two had bone and joint infection and one had liver abscess. The neonates undergoing ET are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed.

Hemolitička bolest novorođenčeta

Introduction/Aim: Haemolytic disease of the newborn is haemolytic anaemia that occurs as a consequence of mismatched blood of the parents, that is, the mismatch of blood elements between the mother and fetus in the ABO or Rh system. The aim of this study is to report a case of haemolytic disease of the newborn which occurred as a result of ABO incompatibility. Case report: Indirect hyperbilirubinemia was registered in a female newborn in the 18th hour of life. The blood group of the newborn was A Rh (D) positive, the direct Coombs test was positive and anti-A antibodies were detected in baby's blood. This case was successfully managed with phototherapy and simple red blood cells transfusion without the need for exchange transfusion. Conclusion: ABO incompatibility can be a major problem in the prenatal, perinatal or neonatal periods. Special attention should be paid to pregnant women whose children from previous pregnancies had hyperbilirubinemia or whose pregnancies were ended in miscarriage.

Intensive phototherapy and oxidant-antioxidant status in infants with jaundice

ObjectiveConventional phototherapy converts unconjugated bilirubin to its oxidation products and consequently causes oxidative stress with lipid peroxidation products. New devices that deliver intensive phototherapy are efficacious in treating severe hyperbilirubinemia and minimizing the need for exchange transfusions. However, the oxidative stress status when using these devices has not been explored. Therefore, we aimed to study the impact of using intensive phototherapy on the oxidant-antioxidant status in severely jaundiced neonates. Study designThis prospective case-control study included term newborns admitted with severe hyperbilirubinemia managed with intensive phototherapy. Baseline oxidant-antioxidant concentrations were compared to healthy controls and re-measured after 8 h of intensive phototherapy exposure. ResultsThe study included 40 cases with severe jaundice and 40 non-jaundiced apparently normal controls. Total serum bilirubin at enrollment was 23.4 ± 4.2 mg/dl that significantly decreased after 8 h of therapy to 15.4 ± 3.4 mg/dl (p < 0.001). The decline of total serum bilirubin was 1 mg/dl/h. Bilirubin: albumin ratio decreased from 3.45 ± 0.28 to 2.7 ± 0.21 (p < 0.001). Total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative stress (TOS) concentrations were lower in cases (p < 0.001, p < 0.001, p = 0.049, and p < 0.001 respectively) compared to controls. Following 8 h of intensive phototherapy, further decline of TAC (p = 0.016) with increased concentrations of TOS (p = 0.005) were noted. SOD and MDA did not change. ConclusionsAlthough efficacious, intensive phototherapy was associated with increased oxidative stress. The clinical correlates for harms related to such oxidative stress need further studying.

Factors affecting the severity of RH Incompatibility newborn

Rh incompatibility is a not common pediatric problem, that cause morbidity and mortality in children, and it is an important cause of hemolysis, anemia and jaundice in newborn. To study Rhesus hemolytic disease, its severity, its complications; to evaluate if ABO incompatibility is protective or not, so to find out the efficacy of anti-D globulin ; to evaluate the efficacy of phototherapy and exchange transfusion as a treatment.&#x0D; This study was done on neonates with jaundice, seventy five patients (1-10 days old) who had Rh incompatibility were studied during period from the first of January 2008 to the 30th of June 2008.&#x0D; History was taken about age, gender and gestational age of the patients, determination of gestational age and hepatosplenomegally as a cause of extramedullary hematopoiesis. Investigations done for patients were hemoglobin, total serum bilirubin, reticulocyte count, blood group and Rh, and direct coombs test. From 75 patients studied, 55 patients (73%) required treatment for jaundice;25 of them (46%) required only phototherapy due to mild degree of hemolysis, and 30 of them (54%) required exchange transfusion with phototherapy due to severe degree of hemolytic. The remaining 20 patients (27%) required observation alone.&#x0D; Family history of previous hemolysis was positive in 44 patients and it was a risk factor for having hemolysis in present pregnancy. Early evaluation of patients for jaundice was useful in early recovery. ABO incompatibility in association with Rh incompatibility was not necessarily protective against hemolysis. The administration of anti-D globulin to the mother within first 72 hours after delivery was protective against sensitization.&#x0D; Early and proper management of of Rh incompatibility may reduce need for exchange transfusion. ABO incompatibility was not necessarily protective against hemolysis. Anti-D globulin administered to mothers within 3 days after delivery was protective against sensitization, History of hemolytic in previous siblings is considered as a risk factor for present hemolytic in neonates with Rh incompatibility.&#x0D;

Outcome of Neonatal Hyperbilirubinemia from a Tertiary Care Hospital in Eastern Nepal: A Cross-sectional Study

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome.&#x0D; Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin &gt;20% of total serum bilirubin or &gt;2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. &#x0D; Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin &gt;20 mg/dl at presentation, duration of phototherapy &gt;44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p &lt; 0.05).&#x0D; Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.