Outcome of exchange blood transfusions done for neonatal jaundice in Abakaliki, South Eastern Nigeria

Abstract

Background:Neonatal jaundice (NNJ) is a major cause of morbidity and mortality among neonates in Nigeria and exchange blood transfusion (EBT) is a common modality of its treatment in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. This communication aims to audit this service.Materials and Methods:A 3-year retrospective review of the case files of all neonates that had EBT for NNJ at the new born special care unit of EBSUTH.Result:Two hundred and thirty seven (17.25%) out of 1374 neonatal admissions had NNJ. EBT was performed for 40 (16.9%) of them. The commonest indications for EBT were low birth weight/prematurity, ABO blood group incompatibility, sepsis and glucose 6 phosphate deficiencies. The mean serum bilirubin at which EBT was done was 28.3 mg/dl. The EBT was uneventful in 36 cases while in four (10%) cases there were reported adverse events. Seven neonates (17.5%) died after the procedure and documented causes of death include bilirubin encephalopathy, respiratory failure, and septic shock and disseminated intravascular coagulopathy.Conclusion:There is high rate of EBT use in the management of severe neonatal hyperbilirubinemia with significant morbidity and mortality in this study site. There is need to review the contribution of factors such as late presentation in the hospital to this and proffer solutions to it.

Can Post Exchange Blood Transfusion Haematocrit Be Predicted in Neonates?

“…Ibekwe et al [3] retrospectively reviewed the records of 40 babies who had double volume ET for neonatal jaundice from the Eastern part of Nigeria and documented a mean pre ET haematocrit of 35.92(7.71), which was lower than what we got in this study. The post EBT haematocrit was however not documented in their study.…”

“…It is estimated that at the conclusion of a double volume exchange transfusion, about 90% of baby's blood would have been exchanged. While ET is rarely done in most developed countries, it is a common lifesaving therapeutic procedure in Nigeria where severe neonatal hyperbilirubinaemia is frequently encountered [2][3][4][5].…”

Efficacy of Intravenous immunoglobulin and phototherapy in the management of extreme-hyperbilirubinaemia: A Case Report

“…EBT is, therefore, a common modality of treatment for severe neonatal jaundice in developing countries like Nigeria. [5,6] Literature and data are sparse from these regions in the use of standardised guidelines and IVIG in the management of NNJ. Therefore, the present case is presented to illustrate the use and response of IVIG in the management of extreme hyperbilirubinaemia.…”

“…[3] Some of the complications of exchange transfusion include haemodynamic instability, apnea, pulmonary haemorrhage, thrombocytopaenia, coagulopathies, hypoglycaemia, hypocalcaemia, electrolyte imbalance, vasospasm, vascular thromboses, hypertension, arrhythmias, sepsis, necrotizing enterocolitis and bowel perforation with morbidity rates varying from 2.8-5.2% per procedure. [3][4][5] While international guidelines for the management of neonatal jaundice are widely available and accessible globally; uniform practice guidelines are rare at all levels of healthcare delivery in Nigeria. [4] The threshold for EBT is often based on a TSB level of ≥ 20mg/dL and two-third of that level for commencing PT for term babies.…”

“…[4] The threshold for EBT is often based on a TSB level of ≥ 20mg/dL and two-third of that level for commencing PT for term babies. [5] Intravenous Immunoglobulin (IVIG) is an alternative therapy which may be effective in treating isoimmunehaemolytic jaundice. In isoimmunehaemolysis, red blood cells are proba-bly destroyed by an antibody-dependent cytotoxic mechanism mediated by Fc receptor bearing cells of the neonatal reticuloendothelial system.…”