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Treatment
GDG translation from evidence
The GDG accepts that the use of white curtains as an adjunct to phototherapy can aid serum
bilirubin reduction but, because their use compromises the ability to observe the baby, the
GDG does not recommend their use.
Using incubators or bassinets
Description of included studies
No studies were identified.
Review findings
No studies were identified.
Evidence summary
No evidence was identified.
GDG translation from evidence
As no evidence was identified, the GDG cannot recommend the use of incubators or bassinets
for the treatment of hyperbilirubinaemia and considers that clinical considerations and
availability should determine whether either of these are used to nurse babies who require
phototherapy. Babies should be nursed in a thermo-neutral environment, in other words, in
surroundings of an ambient temperature that minimises their energy expenditure on keeping
warm or cool.
Recommendations – 7.2.4 Additional equipment
Use incubators or bassinets according to clinical need and availability.
Do not use white curtains routinely with phototherapy as they may impair observation of the
baby.
7.3 Exchange transfusion
Clinical question
i) How effective is exchange transfusion?
ii) What is the best method (single-volume versus double-volume exchange)?
iii) What are the criteria/indications for carrying out an exchange transfusion?
Description of included studies
Following electronic searches, 103 records were identified and 17 hard-copy articles were
requested. Following expert advice, five more hard-copy articles were ordered so a total of 22
studies were included. Initially, only RCTs were to be included but, due to the paucity of data
on adverse effects reported in these studies, the scope was expanded to include lower quality
studies that reported adverse effects.
Review findings
Double-volume exchange transfusion
In six RCTs, 193-199 double-volume exchange transfusion (DVET) was compared with alternative
treatment strategies. Exchange transfusion was generally performed using the umbilical vein and acid
citrate dextrose (ACD) or citrate phosphate dextrose (CPD) blood less than 2 or 5 days old. The
volume of blood used was 75–170 ml/kg body weight. Exchange transfusions were initiated at
varying serum bilirubin levels, the lowest being 256.5 micromol/litre in preterm babies and
307.8 micromol/litre in term babies. In one RCT 194;195 reported in two articles, exchange transfusions
were carried out within 9 hours of birth in babies with haemolytic disease of the newborn.
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