Hiperbilirubinemi nedeniyle kan değişimi uygulanan zamanında doğmuş bebeklerin klinik özellikleri ve kan değişimi nedenleri Orijinal Araştırma

Ali Bülbül; Füsun Okan; Nurşen Ciğerci; Asiye Nuhoğlu

Clinical characteristics and causes of exchange transfusion in term neonates with hyperbilirubinemia Original Article

Yıl 2007, Cilt: 42 Sayı: 3, 107 - 111, 01.09.2007

Ali Bülbül Füsun Okan Nurşen Ciğerci Asiye Nuhoğlu

Öz

Aim: The aim of this study is to evaluate the clinical characteristics of term newborns who have had exchange transfusion and identify the etiology of hyperbilirubinemia Material and Method: This was a retrospective medical chart review The records of 45 term newborns who were admitted from January 2002 to December 2006 with the diagnosis of hyperbilirubinemia and had exchange transfusion were reviewed Exchange transfusion was made according to the guidelines proposed by the American Academy of Pediatrics Results: A total of 49 exchange transfusions were made in 45 patients Exchange transfusions were performed twice in two patients and three times in one patient The gender gestational age and mean birth weight of infants were 62 males 38 females 38 7 ± 0 7 weeks and 3237 ± 557 gr range : 2100 5190 gr respectively The proportion of the complaints suggested by the parents were; neonatal jaundice 64 4 n:29 feeding difficulties 11 1 n:5 respiratory difficulty dyspnea 6 6 n:3 and irritabilty retrocollis 4 4 n:2 At the hospital admission their mean body weight was 2970 ± 551 gr range : 1740 5110 gr mean postnatal age was 4 7 ± 2 5 days range : 1 13days and mean total serum bilirubin level was 28 1 ± 7 8 mg dl range : 12–46 5 mg dl Exchange transfusion was made with in 2 3 ± 1 7 hours range: 1 5 hours after admission Hemolytic disease was found in 55 5 of the infants n:25 The most common causes of hemolysis were sensitization to ABO n:9 Rh n:6 ABO Rh n:2 other blood group antigens n:2 glucose 6 phosphate dehydrogenase deficiency n:1 urinary tract infection n:1 sepsis n:1 and unknown n:3 The underlying cause was not identified in 46 6 n:21 of cases Conclusions: This study confirms that half of the causes were not identified in term newborns who had exchange transfusion due to hyperbilirubinemia The common causes were sensitization to ABO Rh other blood group antigens glucose 6 phosphate dehydrogenase deficiency and sepsis Excessive weight loss has been high in this group The need for exchange transfusion could be reduced by following the infant closely after discharge and by educating parents about jaundice Turk Arch Ped 2007; 42: 107 11 Key words: Term newborn exchange transfusion etiology hyperbilirubinemia weight loss

Anahtar Kelimeler

-

Kaynakça

Subcommittee on Hyperbilirubinemia. Management of hyper- bilirubinemia in the newborn infant 35 or more weeks of ges- tation. Pediatrics 2004; 114: 297-316.
Jackson CJ. Adverse events associated with exchange trans- fusion in healthy and ill newborns. Pediatrics 1997; 99: 7-13.
Ip S, Chung M, Kulig J, et al. An evidence-based review of im- portant issues concerning neonatal hyperbilirubinemia. Pediat- rics 2004; 114: 130-53.
Newman TB, Maisels MJ. Less aggressive treatment of neona- tal jaundice and reports of kernicterus: Lessons about practi- ce guidelines. Pediatrics 2000; 105: 242-5.
Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ 2006; 175: 587- 90.
Dubowitz LM, Dubowitz V, Palmer P, Verghote M. A new app- roach to the neurological assessment of the preterm and full- term newborn infant. Brain Dev 1980; 2: 3-14.
Maisels MJ, Kring E. Length of stay, jaundice, and hospital re- admission. Pediatrics 1998; 101: 995-8.
Akın MA, Kavuncuoğlu S, Özbek S, ve ark. Erken taburcu olan yenidoğanlarda yeniden hastaneye yetış nedenleri ve sonuçla- rı. Türk Pediatri Arşivi 2006; 41: 201-7.
Sanpavat S. Exchange transfusion and its morbidity in ten-ye- ars period at King Chulalongkorn Hospital. J Med Assoc Thai 2005; 88: 588-92.
Katar S, Devecioğlu C, Özel AK, Sucaklı İ. Kan değişimi yapı- lan bebeklerde hiperbilirubinemi etiolojisinin değerlendirilmesi. Dicle Tıp Dergisi 2006; 33: 174-7.
Johnson LH, Bhutani VK, Brown AK. System-based approach to management of neonatal jaundice and prevention of kernic- terus. J Pediatr 2002; 140: 396-403.
Atay E, Bozaykut A, Ipek IO. Glucose-6-phosphate dehydro- genase deficiency in neonatal indirect hyperbilirubinemia. J Trop Pediatr 2006; 52: 56-8.
Bülbül A, Okan F, Uslu S, İşçi E, Nuhoğlu A. Term bebeklerde hiperbilirubineminin klinik özellikleri ve risk etmenlerinin araştı- rılması. Türk Pediatri Arşivi 2005; 40: 204-10.
Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics 2001; 107: 41-5.
Bertini G, Dani C, Pezzati M, Rubaltelli FF. Prevention of bilirübin encephalopathy. Biol Neonate 2001; 79: 219-23.
Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent sig- nificant hyperbilirubinemia in healthy term and near-term new- borns. Pediatrics 1999; 103: 6-14.