I want your opinion about the cases of severe hyperbilirubinemia that in need for exchange transfusion

In our unit, the policy is to start with double or triple phototherapy with close follow up of the case, then we repeat the serum bilirubin after 2-4 hours .. if there is marked drop (>2mg/dl) we continue on double phototherapy .. if not shift to exchange transfusion.

we do that to decrease the risks of exchange transfusion and a trial till the preparation of required blood for exchange.

so what is your opinions in that:

it is better to start with exchange transfusion immediately or try first phototherapy.

Generally, we start with intensive phototherapy and take a new sample after 4-8 hours, depending on the starting point. If the s-bili does not increase during this time, we usually check s-bili again after another 6-12 hours.

Of course, if the level is very high from the beginning we may start off with an exchange transfusion.

I add the link to the new national reference curve:

http://blf.net/neonatol/Bil1_%20Bili.pdf

It is in Swedish... but I think you get the message. The highest line is when exchange transf should be considered. Levels above the line below that one - consider phototherapy.

I agree to Alexander that in the most cases it is worth to try intensive phototherapy before switching to exchangetransfusion.

I this context you'll find an interesting article in Pediatrics (2008):

Outcomes in a Population of Healthy Term and Near-Term Infants With Serum Bilirubin Levels of >325 µmol/L (>19 mg/dL) Who Were Born in Nova Scotia, Canada, Between 1994 and 2000.

http://pediatrics.aappublications.org/cgi/content/abstract/122/1/119

Firstly, we begine treating Hyperbilirubinaemia with Phototherapy, double or triple with follow up S- bilirubin for 4-6 hours depending on the level of serum bilirubin, at the same time we look for the cause of hyperbilirubinaemia and the age of the baby/ THIS IS IMPORTANT/

Note: if there is no hemolysis, we try to use phototherapy and feeding as the best way.

dr Hasan Nimer

Aleeman Hospital

department of children and neonatology

JORDAN

Another measure can be taken after intensive triple phototherapy, in case of hemolysis adn before exchange transfusion is giving IV IG 0.5g -1g/kg over 2h (Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316).

A useful tool on the net is www.bilitool.org: you plug in the serum bili level, the age of the baby in hours and you get suggestions on what to do....

I want your opinion about the cases of severe hyperbilirubinemia that in need for exchange transfusion

In our unit, the policy is to start with double or triple phototherapy with close follow up of the case, then we repeat the serum bilirubin after 2-4 hours .. if there is marked drop (>2mg/dl) we continue on double phototherapy .. if not shift to exchange transfusion.

we do that to decrease the risks of exchange transfusion and a trial till the preparation of required blood for exchange.

so what is your opinions in that:

it is better to start with exchange transfusion immediately or try first phototherapy.

Edited April 6, 200916 yr by a_emnaina

i am making research about intensive photo therapy please if anyone knows any internet site i can return to it to help me in my research