Page 160 - 16Neonatal Jaundice_compressed

Treatment

rebound hyperbilirubinaemia. There were no cases of kernicterus or reported adverse effects in
either group. [EL 1−]
The sixth RCT, 199 carried out in the USA, compared DVET with exchange transfusion with
frozen erythrocytes diluted in plasma. The sample was divided into low-birthweight (< 2500 g)
and appropriate-birthweight (> 2500 g) groups, and subjects within each group were randomly
allocated to either treatment. Neither allocation concealment nor the method of randomisation
was reported but there were no significant differences between the groups on any baseline
variable. In the low-birthweight group the mean gestational age of the sample was
32.6 ± 3.2 weeks, the mean birthweight was 1670 ± 434 g, and the mean serum bilirubin was
304 ± 48 micromol/litre, while in the appropriate-birthweight group the mean gestational age of
the sample was 39.1 ± 1.8 weeks, the mean birthweight was 3234 ± 494 g, and the mean serum
bilirubin was 328 ± 25 micromol/litre There was no statistically significant difference between
DVET and frozen erythrocytes in mean reduction of serum bilirubin or in the number of
treatment failures or deaths. There were no cases of kernicterus or reported adverse effects in
either group. [EL 1−]

Side effects of DVET
A non-randomised controlled study from India 201 examined the role of calcium in exchange
transfusion by alternately allocating subjects to either DVET or to DVET with 1 ml of 10%
calcium gluconate intravenously for every 100 ml of CPD blood exchanged. Sample
demographics were not reported. No jaundice-related outcome data were presented but one
baby who received calcium had a cardiac arrest. The authors concluded that the administration
of calcium had no role in exchange transfusion. [EL 1−]
A study from India, 202 using historical controls, compared exchange transfusion through
peripheral vessels, either brachial or radial artery, with exchange via the umbilical vein. Of 198
babies who underwent exchange transfusion, 90 were exchanged through peripheral vessels,
using the brachial or radial artery on one side and a good peripheral or antecubital vein on the
other side. No major complications were observed, although two babies who received
exchange transfusions through the radial artery suffered from transient blanching of the hand.
The perceived advantage of peripheral exchange transfusions was that feeding could be
continued while the procedure was taking place. [EL 3]
Another retrospective chart review from the USA 203 examined the adverse effects of exchange
transfusion over a 10-year period. Babies < 30 days old who had received at least one
exchange transfusion for hyperbilirubinaemia were included. In all, 55 babies underwent a total
of 66 exchange transfusions. The mean gestational age of the sample was 35 ± 4 weeks and the
mean birthweight was 2388 ± 973 g. Thirty (55%) of the sample were male. The mean serum
bilirubin was 307.8 ± 136.8 micromol/litre. An adverse event was attributed if it occurred within
7 days of exchange transfusion. One baby died and another suffered seizures. The most
common adverse effects were thrombocytopenia (22 babies), hypocalcaemia (19), catheter
malfunction (six), hypotension (five), venous thrombosis (two), hypokalaemia (two) and
hypoglycaemia (two). One baby each suffered from bradycardia, acute renal failure and
omphalitis. [EL 3]
A third retrospective chart review in the USA 204 reported the adverse effects of exchange
transfusion over a 15-year period. The sample (n = 106) was divided into two groups, those with
hyperbilirubinaemia (n = 81) and those with co-morbid medical problems (n = 25). The mean
gestational age was 36.6 ± 3.6 weeks and the mean body weight was 2846 ± 806 g. The 106
babies included had a total of 140 exchange transfusions. Repeat exchange transfusions were
more commonly needed among those with co-morbid medical problems. Three babies died of
causes probably attributable to exchange transfusion, while four suffered permanent serious
sequelae (defined as serious complications that resulted in permanent bodily alterations) and
four suffered serious prolonged complications (defined as symptomatic patients with serious
problems whose problems eventually resolved). The most common adverse effects were related
to hypocalcaemia (one death and 26 requiring treatment) and thrombocytopenia (two deaths
and 15 requiring treatment). Twelve babies experienced catheter malfunctions (due to clotting)
requiring a replacement catheter and/or discontinuation of treatment. [EL 3]

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