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YENİDOĞAN KAN DEĞİŞİMİ: DÖRT YILLIK ANKARA HASTANESİ DENEYİMİ

Year 2008, Volume: 9 Issue: 2, 5 - 10, 01.08.2008

Abstract

Amaç:Bu çalışmada yenidoğan döneminde hiperbilirubinemi nedeniyle kan değişimi (KD) uygulananhastalarda etiyoloji, komplikasyon ve tedavinin yakın dönem sonuçlarının belirlenmesi amaçlanmıştır.Gereç ve Yöntem:Ocak 1998 ve Aralık 2001 tarihleri arasında S.B. Ankara Eğitim ve Araştırma HastanesiPediatri 1 ve 2 Kliniklerinde hiperbilirubinemi nedeniyle takip edilen hastalar retrospektif olarak değerlendirildi.Dört yıllık sürede 1152 hastanın hiperbilirubinemi nedeniyle izlendiği ve bunlardan 79'unda 91 kan değişimiuygulandığı belirlendi.Bulgular:Ortalama başvuru yaşı 4,1 ± 2,7 gündü. Olguların %36,7'sinde (n=29)ABO uygunsuzluğu , %6,3'ünde(n=5) Rh uygunsuzluğu mevcuttu ve %1,2'sinde hem ABO hem de Rh uygunsuzluğu mevcuttu. Kan değişimiöncesi ve sonrası bilirubin, kalsiyum,hemoglobin düzeyi ve trombosit sayıları arasında anlamlı farkbulunmaktadır. (p< 0,05) Kan değişimi uygulanan 45 hastada (%56,9) komplikasyon belirlenmiştir.Komplikasyon olarak kardiyopulmoner arrest %1,2 (n=1); sepsis %2,5 (n=2); trombositopeni %25,3 (n=20);anemi %37,9 (n=30) ve hiperkalsemi %36,7 (n=29) olguda saptanmıştır.Sonuç:Kan değişimi yenidoğanın ciddi hiperbilirubinemisinin etkili tedavisinde halen altın standart olmaözelliğini korumaktadır. ABO uygunsuzluğunun daha hafif hastalık oluşturduğu bilinmektedir, ancak serimizde% 36,7 hastada ABO uygunsuzluğu olan hastalara KD uygulandığı saptandı. Bu çalışmada KD gerektiren enönemli nedenin ABO uygunsuzluğu olduğu belirlendi. Fototerapiye rağmen geç getirilen veya çok yüksek totalbilirubin düzeyi ile başvuran hastalarda KD komplikasyon riski kern ikterus gelişme riskinden düşük olduğusürece KD geciktirilmemelidir. Günümüzde KD pratiği giderek azaldığından komplikasyonları en aza indirmekiçin deneyimli merkezlerde uygulanmalıdır. Antenatal dönemde tüm gebeler ve eşlerinde kan grupları, Rh veABO uygunsuzluğu riski önceden belirlenmeli ve doğumun sağlık personeli gözetiminde gerçekleşmesisağlanmalıdır

References

  • 1- Stoll BJ, Blood Disorders In: Kliegman RM, Jenson HB, Behrman RE, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Elsevier, Philadelphia, 2007: 766-74.
  • 2- Penn AA, Enzmann DR, Hahn JS, Stevenson DK. Kernicterus in a full term infant. Pediatrics 1994; 93: 1003-6.
  • 3- Haris MC, Bernbaum JC, Polin JR, Zimmerman R, Polin RA. Developmental follow-up of breastfed term and near-term infants with marked hyperbilirubinemia. Pediatrics 2001; 107: 1075-80.
  • 4- Newman TB, Maisels MJ. Less Aggressive treatment of neonatal jaundice and reports of kernicterus: lessons about practice guidelines. Pediatrics 2000; 105: 242-5.
  • 5- Dennery PA, Seidman SD, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001; 344: 581-90.
  • 6- MacDonald MG. Hidden risks: early discharge and bilirubin toxicity due to glucose 6-phosphate dehydrogenase deficiency. Pediatrics 1995; 96: 734-8.
  • 7- Mollison PL, Walker W. Controlled trials of the treatment of haemolytic disease of the newborn. Lancet 1952; 1(9): 429-33.
  • 8- Steinhorn RH. Exchange transfusion of the newborn In: Goodman DM, Green TP, Unti SM, Powel EC editors. Lange current procedures: pediatrics, 1st ed. Mc Graw Hill, NewYork,2007: 304-6.
  • 9- JA Stockman 3rd. Overview of the state of the art of Rh disease: history, current clinical management, and recent progress. J Pediatr Hematol Oncol 2001; 23(8): 554-62.
  • 10- AAP Subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297-316.
  • 11- Madan A, McMahan J, Stevenson D. Neonatal Hyperbilirubinemia. In: Taeusch HW, Ballard RA, Gleason CA editors. Avery's disease of the newborn, 8th ed. Elsevier, Philadelphia, 2004: 1247.
  • 12- Sarici SÜ, Yurdakök M, Serdar MA, Oran O, Erdem G, Tekinalp G, Yigit S. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics 2002; 109: e53.
  • 13- Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, Maisels MJ, Lau J, Subcommittee on hyperbilirubinemia An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004; 114: e130 - e153.
  • 14- Watchko JF. Vigintiphobia revisited. Pediatrics 2005; 115: 1747-53.
  • 15- Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics 1997; 99: e7.
  • 16- Badiee Z. Exchange transfusion in neonatal hyperbilirubinemia: experience in Isfahan, Iran. Singapore Med J 2007; 48(5): 421-3.
  • 17- Abu-Ekteish F, Daoud A, Rimawi H, Kakish K, AbuHeija A. Neonatal exchange transfusion: a Jordanian experience.Ann Trop Paediatr 2000; 20(1): 57-60.
  • 18- Ozmert E, Erdem G, Topcu M, Yurdakok M, Tekinalp G, Genc D, Renda Y. Long-term follow-up of indirect hyperbilirubinemia in full-term Turkish infants. Acta Paediatr 1996; 85(12): 1440-4.
  • 19- Yilmaz Y, Karadeniz L, Yildiz F, Degirmenci SY, Say A. Neurological prognosis in term newborns with neonatal indirect hyperbilirubinemia. Indian Pediatr 2001; 38(2): 165-8.
  • 20- Holmes GE, Miller JB, Smith EE. Neonatal bilirubinemia in production of long-term neurological deficits. Am J Dis Child 1968; 116: 37.
  • 21- Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES, Escobar GJ, the jaundice and infant feeding study team. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006; 354: 1889-1900.
  • 22- Blanchette V, Chan A, Dror Y. Anemias. In: Mc Donald MG, Seshia MM, Mullett MD, editors. Avery's Neonatology, 6th ed. Lippincott Williams & Wilkins, Philadelphia, 2005:1169-90.
  • 23- Provisional Committee on Quality Improvement Subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558-65.
  • 24- Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103: 6- 14.
  • 25- Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Can MedAssoc J 2006; 175: 587- 90.
  • 26- Maisels MJ, Watchko JF. Treatment of jaundice in low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2003; 88: 459.
  • 27- Katar S, Devecioğlu C, Özel AK, Sucaklı İ. Kan değişimi yapılan hiperbilirubinemili bebeklerde etiyolojinin değerlendirilmesi. Dicle Tıp Dergisi 2006; 33(3): 174-7.
  • 28- Ghaemi S, Feskaraki RJ, Kelishad R. Late onset jaundice and urinary tract infection in neonates. Indian J Pediatr 2007; 74(2): 139-41.
  • 29- Bülbül A, Okan F, Uslu S, İşçi E, Nuhoğlu A. Term bebeklerde hiperbilirbineminin klinik özellikleri ve risk etmenlerinin araştırılması. Türk Pediatri Arşivi 2005; 40:204-10.
  • 30- Alpay F. Sarılık. In: Yurdakök M, Erdem G. Neonataloji 1. baskı, Alp Ofset Basımevi, Ankara, 2004: 559-78.
  • 31- Adams JA, Hey DJ, Hall RT. Incidence of Hyperbilirubinemia in breast- vs. formula-fed infants. Clinical Pediatrics 1985; 24: 69-73.
  • 32- Ateş E, Bozoğlu A, İpek IO. Glucose 6 phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr 2006; 52: 56-8.
  • 33- Soulie JC, Larsen M, Andreu G, Berry M, Gabai A, Galiay JC, Genho-Hreiche G, de Lachaux V, Lattes F, Malvoisin A, Maynier M, Pernot F, Sender A, Brossard Y. Retrospective study of exchange transfusion for newborn infants with reconstituted blood. Review of 60 exchanges. Transfus Clin Biol 1999; 6(3): 166-73.
  • 34- Güle r V, A rmağan E. Kan transfüzyonu komplikasyonları. Sürekli Tıp Eğitimi Dergisi (STED) 2003; 12(11): 421-3.
  • 35- Patra K, Storfer-Isser A, Siner B, Moore J, Hack M. Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr 2004; 144(5): 626- 31.
  • 36- Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics 2007; 120(1): 27- 32.
  • 37- Thayyil S, Milligan DW. Single versus double volume exchange transfusion in jaundiced newborn infants. Cochrane Database Syst Rev 2006; 18(4): Cd004592.
  • 38- Alexader DC, Robin B. Neonatology. In: Sibery GK, Iannone R editors. The harriet lane handbook of pediatrics, 6th ed. Mosby Inc, St. Louise, 2000:417- 60.
  • 39- Locham KK, Kaur K, Tandon R, Kaur M, Garg R. Exchange blood transfusion in neonatal hyperbilirubinemia-role of calcium. Indian Pediatr 2002; 39(7): 657-9.
  • 40- Weinstein R. Hypocalcemic toxicity and atypical reactions in therapeutic plasma exchange. J Clin Apher 2001; 16(4): 210-1.
  • 41- Downes K, Sarode R. Massive blood transfusion. Indian J Pediatr 2001; 68(2): 145-9.
  • 42- Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005; 159: 113-9.

Neonatal Exchange Transfusion: Experience of a State Hospital in Ankara During a Four Year Period

Year 2008, Volume: 9 Issue: 2, 5 - 10, 01.08.2008

Abstract

Purpose: We aimed to determine the etiology, complications and treatment outcome of patients who underwent exchange transfusion (ET) for neonatal hyperbilirubinemia in our hospital. Materials and Methods: This retrospective study was performed at Ankara State Hospital between January 1998 and December 2001. Among 1152 patients admitted for hyperbilirubinemia 91 exchange transfusions which were performed on 79 (6.86%) neonates were evaluated. Results: Mean age at admission was 4.1 2.7 days.ABOincompatibility was detected in 29 (36.7 %) cases andRh incompatibility in 5 (6.3%) cases and one case had bothABO and Rh incompatibility. Hemoglobin (Hb), calcium, bilirubin and platelet count before and after ET showed statistically significant difference(p<0.05). Exchange transfusion complications occurred in 45 neonates (56.9%). These were: anaemia n=30 (37.9%); hypercalcemia n=29 (36.7%); thrombocytopenia n=20 (25.3%) sepsis n=2 (2.5%); cardiopulmonary arrest n=1 (1.2%) Conclusion: ET is still the gold standard for treatment of severe neonatal hyperbilirubinemia. In our seriesABO incompatibility was found to be the most common cause of neonatal jaundice. The morbidity caused by ET is high; therefore it should be performed in clinics which were responding to these complications of ET. When the risks of hyperbilirubinemia overweigh ET complications, ET must not be delayed. All pregnancies must be investigated forABOincompatibility during the prenatal period and labour must take place in a medical centre.

References

  • 1- Stoll BJ, Blood Disorders In: Kliegman RM, Jenson HB, Behrman RE, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Elsevier, Philadelphia, 2007: 766-74.
  • 2- Penn AA, Enzmann DR, Hahn JS, Stevenson DK. Kernicterus in a full term infant. Pediatrics 1994; 93: 1003-6.
  • 3- Haris MC, Bernbaum JC, Polin JR, Zimmerman R, Polin RA. Developmental follow-up of breastfed term and near-term infants with marked hyperbilirubinemia. Pediatrics 2001; 107: 1075-80.
  • 4- Newman TB, Maisels MJ. Less Aggressive treatment of neonatal jaundice and reports of kernicterus: lessons about practice guidelines. Pediatrics 2000; 105: 242-5.
  • 5- Dennery PA, Seidman SD, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001; 344: 581-90.
  • 6- MacDonald MG. Hidden risks: early discharge and bilirubin toxicity due to glucose 6-phosphate dehydrogenase deficiency. Pediatrics 1995; 96: 734-8.
  • 7- Mollison PL, Walker W. Controlled trials of the treatment of haemolytic disease of the newborn. Lancet 1952; 1(9): 429-33.
  • 8- Steinhorn RH. Exchange transfusion of the newborn In: Goodman DM, Green TP, Unti SM, Powel EC editors. Lange current procedures: pediatrics, 1st ed. Mc Graw Hill, NewYork,2007: 304-6.
  • 9- JA Stockman 3rd. Overview of the state of the art of Rh disease: history, current clinical management, and recent progress. J Pediatr Hematol Oncol 2001; 23(8): 554-62.
  • 10- AAP Subcommittee on hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297-316.
  • 11- Madan A, McMahan J, Stevenson D. Neonatal Hyperbilirubinemia. In: Taeusch HW, Ballard RA, Gleason CA editors. Avery's disease of the newborn, 8th ed. Elsevier, Philadelphia, 2004: 1247.
  • 12- Sarici SÜ, Yurdakök M, Serdar MA, Oran O, Erdem G, Tekinalp G, Yigit S. An early (sixth-hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics 2002; 109: e53.
  • 13- Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, Maisels MJ, Lau J, Subcommittee on hyperbilirubinemia An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004; 114: e130 - e153.
  • 14- Watchko JF. Vigintiphobia revisited. Pediatrics 2005; 115: 1747-53.
  • 15- Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics 1997; 99: e7.
  • 16- Badiee Z. Exchange transfusion in neonatal hyperbilirubinemia: experience in Isfahan, Iran. Singapore Med J 2007; 48(5): 421-3.
  • 17- Abu-Ekteish F, Daoud A, Rimawi H, Kakish K, AbuHeija A. Neonatal exchange transfusion: a Jordanian experience.Ann Trop Paediatr 2000; 20(1): 57-60.
  • 18- Ozmert E, Erdem G, Topcu M, Yurdakok M, Tekinalp G, Genc D, Renda Y. Long-term follow-up of indirect hyperbilirubinemia in full-term Turkish infants. Acta Paediatr 1996; 85(12): 1440-4.
  • 19- Yilmaz Y, Karadeniz L, Yildiz F, Degirmenci SY, Say A. Neurological prognosis in term newborns with neonatal indirect hyperbilirubinemia. Indian Pediatr 2001; 38(2): 165-8.
  • 20- Holmes GE, Miller JB, Smith EE. Neonatal bilirubinemia in production of long-term neurological deficits. Am J Dis Child 1968; 116: 37.
  • 21- Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES, Escobar GJ, the jaundice and infant feeding study team. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006; 354: 1889-1900.
  • 22- Blanchette V, Chan A, Dror Y. Anemias. In: Mc Donald MG, Seshia MM, Mullett MD, editors. Avery's Neonatology, 6th ed. Lippincott Williams & Wilkins, Philadelphia, 2005:1169-90.
  • 23- Provisional Committee on Quality Improvement Subcommittee on hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994; 94: 558-65.
  • 24- Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103: 6- 14.
  • 25- Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Can MedAssoc J 2006; 175: 587- 90.
  • 26- Maisels MJ, Watchko JF. Treatment of jaundice in low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2003; 88: 459.
  • 27- Katar S, Devecioğlu C, Özel AK, Sucaklı İ. Kan değişimi yapılan hiperbilirubinemili bebeklerde etiyolojinin değerlendirilmesi. Dicle Tıp Dergisi 2006; 33(3): 174-7.
  • 28- Ghaemi S, Feskaraki RJ, Kelishad R. Late onset jaundice and urinary tract infection in neonates. Indian J Pediatr 2007; 74(2): 139-41.
  • 29- Bülbül A, Okan F, Uslu S, İşçi E, Nuhoğlu A. Term bebeklerde hiperbilirbineminin klinik özellikleri ve risk etmenlerinin araştırılması. Türk Pediatri Arşivi 2005; 40:204-10.
  • 30- Alpay F. Sarılık. In: Yurdakök M, Erdem G. Neonataloji 1. baskı, Alp Ofset Basımevi, Ankara, 2004: 559-78.
  • 31- Adams JA, Hey DJ, Hall RT. Incidence of Hyperbilirubinemia in breast- vs. formula-fed infants. Clinical Pediatrics 1985; 24: 69-73.
  • 32- Ateş E, Bozoğlu A, İpek IO. Glucose 6 phosphate dehydrogenase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr 2006; 52: 56-8.
  • 33- Soulie JC, Larsen M, Andreu G, Berry M, Gabai A, Galiay JC, Genho-Hreiche G, de Lachaux V, Lattes F, Malvoisin A, Maynier M, Pernot F, Sender A, Brossard Y. Retrospective study of exchange transfusion for newborn infants with reconstituted blood. Review of 60 exchanges. Transfus Clin Biol 1999; 6(3): 166-73.
  • 34- Güle r V, A rmağan E. Kan transfüzyonu komplikasyonları. Sürekli Tıp Eğitimi Dergisi (STED) 2003; 12(11): 421-3.
  • 35- Patra K, Storfer-Isser A, Siner B, Moore J, Hack M. Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr 2004; 144(5): 626- 31.
  • 36- Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics 2007; 120(1): 27- 32.
  • 37- Thayyil S, Milligan DW. Single versus double volume exchange transfusion in jaundiced newborn infants. Cochrane Database Syst Rev 2006; 18(4): Cd004592.
  • 38- Alexader DC, Robin B. Neonatology. In: Sibery GK, Iannone R editors. The harriet lane handbook of pediatrics, 6th ed. Mosby Inc, St. Louise, 2000:417- 60.
  • 39- Locham KK, Kaur K, Tandon R, Kaur M, Garg R. Exchange blood transfusion in neonatal hyperbilirubinemia-role of calcium. Indian Pediatr 2002; 39(7): 657-9.
  • 40- Weinstein R. Hypocalcemic toxicity and atypical reactions in therapeutic plasma exchange. J Clin Apher 2001; 16(4): 210-1.
  • 41- Downes K, Sarode R. Massive blood transfusion. Indian J Pediatr 2001; 68(2): 145-9.
  • 42- Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005; 159: 113-9.
There are 42 citations in total.

Details

Other ID JA37HU52ZH
Journal Section Research Article
Authors

Ülkü Tıraş This is me

Resul Yılmaz This is me

Yıldız Dallar This is me

Publication Date August 1, 2008
Published in Issue Year 2008 Volume: 9 Issue: 2

Cite

EndNote Tıraş Ü, Yılmaz R, Dallar Y (August 1, 2008) Neonatal Exchange Transfusion: Experience of a State Hospital in Ankara During a Four Year Period. Meandros Medical And Dental Journal 9 2 5–10.