Predictors of Repeat Exchange Transfusion for Severe Neonatal Hyperbilirubinemia复制标题

重复换血治疗重症新生儿高胆红素血症的预测因素

The high proportion of ABO incompatibility among infants with ET/RET deserves attention based on several reports that found this factor as the most prevalent among infants who received ET and/or RET. For example, in one study from Iran in which 176 ETs were administered to 150 neonates, ABO incompatibility was the commonest, reported in 49.2% of the infants who had ET and 45% of the 20 infants with RET . Another study from Turkey showed that ABO incompatibility was the most common (27.8%) in the 306 infants who received ET; 8.8% of whom required RET. In fact, ABO incompatibility was predictive of ET/RET among infants with severe hyperbilirubinemia in this cohort (data not shown). Although Rhesus incompatibility was rare in our study, few studies have reported this factor as the most common among infants who had ET in their populations. This underscores the heterogeneity in the genetic and epidemiologic prole across populations, even in LMICs. Mortality was rarely associated with RET in this setting, suggesting that ET is generally protective if done promptly and effectively but not without the risk of other adverse events (4–10).A few limitations of this retrospective study are worth noting. First, like most clinical chart reviews, the available information was limited to what was considered necessary or attainable at the point of care. As a result, some relevant data, including the G6PD status and degree of weight loss at admission, were not available for analysis. Second, the diagnostic validity of some of the variables could not be independently evaluated, although no spurious results emerged from our analyses. Third, it was dif cult to evaluate the degree of compliance with the treatment protocol over the study period, including information on the duration of phototherapy and accurate reporting of peak TSB. Fourth, no data on adverse events associated with ET or the pattern of postexchange TSB levels were provided. Notwithstanding, the keyndings are consistent with evidence in the existing literature and provide priorities for curtailing RET in this and comparable resource-constrained settings.

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