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Treatment

Recommendations – 7.3 Exchange transfusion

Use a double-volume exchange transfusion to treat babies:
• whose serum bilirubin level indicates its necessity (see threshold table (Section 1.3) and
treatment threshold graphs (Section 1.6))
and/or
• with clinical features and signs of acute bilirubin encephalopathy.
During exchange transfusion do not:
• stop continuous multiple phototherapy
• perform a single-volume exchange
• use albumin priming
• routinely administer intravenous calcium.
Following exchange transfusion:
• maintain continuous multiple phototherapy
• measure serum bilirubin level within 2 hours and manage according to threshold table
(Section 1.3) and treatment thresholds graphs (Section 1.6).

7.4 Other treatments

Clinical questions
What are the other ways of treating hyperbilirubinaemia? Are they effective?
What is the effectiveness of the following interventions in treating neonatal
hyperbilirubinaemia/preventing kernicterus?
– metalloporphyrins
– gammaglobulins
– drugs (phenobarbitol, clofibrate, cholestyramine)
– agar, charcoal
– suppositories, other rectal modes of treatment
– complementary/alternative medicines (Chinese herbal remedies such as Yin-chen)

Following electronic searches, which were restricted to controlled trials and reviews, 167
records were identified and 22 hard-copy articles were requested. These were supplemented by
relevant articles identified by earlier searches for the phototherapy review. A total of 61 hard-
copy articles were obtained. For some interventions, no RCTs were identified so other study
types were used in these analyses.

7.4.1 Intravenous immunoglobulin
Intravenous immunoglobulin (IVIG) acts by preventing the destruction of sensitised erythrocytes.
IVIG contains pooled IgG immunoglobulins extracted from the plasma of over 1000 blood
donors. The Department of Health has recently updated their guidance on the use of IVIG
(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_
085235).

Description of included studies
Eleven articles were obtained, including reports of five RCTs 205-209 carried out in Argentina, 205
207
Germany, Iran, Saudi Arabia and Turkey 208 comparing IVIG in combination with
206
209
phototherapy with phototherapy alone for the treatment of haemolytic jaundice. Six articles
were excluded for the following reasons: not randomised (two studies), compared different
dosages of IVIG (one), examined IVIG as prophylaxis to prevent the need for phototherapy
(one), non-English language (one) and conference abstract (one).
One study reported using random numbers to allocate the babies into the treatment groups
208
and using sealed envelopes to conceal the treatment allocation and so was rated EL 1++. None
of the other studies reported the method of randomisation or allocation concealment and so

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