exchange or no!?

[amirmasoud2012]

hi,a neonate 30days,refer to hospital for icter,bil total 30,direct 20,indirect 10(no kern symptom),your plan!(exchange or no)?if indirect 20 and direct10 ,your plan!(exchange or no)?

[raviagarwal]

No, I would not do ET

[Stefan Johansson]

Fr Tw:

 

[chandas]

No need for exchange transfusion at this age and with such high direct bilirubin but needs urgent evaluation for biliary atresia.

[Katja]

No ExTx. Urgent work up!

[dinakar]

No exchange transfusion. Total indirect bilirubin is not that high. but as mentioned above, urgent work up for cholestatic jaundice. 

[Atul Patel]

No exchange required. Check on the color of urine and stools. Investigate for liver pathology and other causes of direct hyperbilirubinemia.

[Naveed]

A few other factors may be important to make that decision. Degree of illness, underlying pathology, Gestational age, BW and postnatal age of the baby. Of course the Threshold for ET will change based on these factors. For example we recently had a full term baby with liver failure due to GALD in which case ET will be needed.

However for an otherwise healthy baby with those numbers ET may not be needed. We had a similar vcase of a baby with inspissated bile syndrome. The direct Bili was elevated for over a month!

[Rao]

no exchange

[celia iglesias neves]

6 hours ago, Katja said:

No ExTx. Urgent work up!

No  i wouldn’t. Most of billirubin is direct. I would look for an hereditary syndrome or an obstrution of bilis like atresia of the biliary system

Good luck!

[Manuel]

No Exchange and work up.

[Seth Malin]

Would not do an ET. Indirect is low and low risk of brain injury

[roserporta]

Hi,   NO, I wouldn't exchange.    Direct bilirrubin is not neurotoxic.  I would focus on an urgent work up for cholestasis is needed.  

[rajnandyal]

Sorry for my inadvertent delay in replying. I found this in my Spam folder, despite my habit of emptying spam folder without looking at them.

It is indeed a very challenging, puzzling and potentially controversial question. I know every one suggested no exchange. Most of the answers

recommended work up for cholestasis.

 

I lean towards agreeing with Dr. Naveed. To start with, there is no good or even fair evidence to support any answer. There were case reports

or anecdotal evidence to support exchange transfusion. During my fellowship, we had a 2 week old baby with klebsiella sepsis, status post-

ECMO got treated with Exchange transfusion, but had mild neurodevelopmental deficits using Bayley II, at 2 years of age. 

 

What will I do? I will do (or delegate) moderately extensive literature search (including Legal/Law literature) and present the information to the

parents (family), and then take a decision (I have worked only in US, and don't know how I would manage in other countries). I will also discuss

with my hospital administration and ourNeonatal exchange transfusion (NET) – what is its current net value.htmlNeonatal exchange transfusion (NET) – what is its current net value.htmlNeonatal exchange transfusion (NET) – what is its current net value.htmlRisk Management. If I decide to do (no way out) double volume exchange transfusion, I will take all

precautions. 

 

Short answer- most likely, I will not do Exchange transfusion, but definitely explain to the infant's parents/family. my reasons.

 The question of neurotoxicity of direct bili, despite the strong belief to the contrary, is still debatable in various clinical scenarios and presence

of risk Neonatal exchange transfusion (NET) – what is its current net value.htmlfactors (gestational age, birth weight, chronological age, sepsis, medications, intracranial hemorrhage,