Fatih KILIÇBAY, Arife TOKSÖZ, Gaffari TUNÇ

Şiddetli neonatal hiperbilirubinemide kurtarma değişimi transfüzyonunun sonuçları

Amaç: Şiddetli hiperbilirubinemili yenidoğanlarda bilirubinin vücuttan uzaklaştırılabilmesi için, kan değişimi (KD) acil bir tedavi yöntemidir. İki yenidoğan yoğun bakım ünitesinde (YYBÜ) KD uygulanan şiddetli hiperbilirubinemili yenidoğanların sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bir üniversite hastanesi ve bir devlet hastanesinin YYBÜ'lerinde ağır hiperbilirubinemi tanısı ile hastaneye yatırıldıktan sonra kan değişimi yapılan 28 yenidoğanın klinik verilerini topladık. Bulgular: Başvuru sırasında medyan serum bilirubin düzeyi 31,2 (20,3-36,8) mg/dL olan 28 yenidoğan çalışmaya alındı. En sık kan değişimi nedeni hemolitik sarılık (%67.8) ve bunu uygun beslenememe (%14) takip ediyordu. Hiperbilirubineminin en sık nedeninin Rh uyuşmazlığı olduğu bulundu. Kan değişimi ile ilişkili bildirilen advers olay oranı %71 idi. KD'ye bağlı en sık görülen komplikasyonlar trombositopeni ve anemi idi. İşlem sonrası 4 bebek hayatını kaybetti. Yenidoğanların %39'unda akut bilirubin ensefalopatisi (ABE) tespit edildi. ABE'li yenidoğanlarda serum bilirubin ve bilirubin/albümin oranları yüksek bulundu. Sonuç: Özellikle hemolitik sarılıkla ilişkili ciddi hiperbilirubinemisi olan yenidoğanların kurtarma ET'sine ihtiyacı olabilir. Bilirubin/albümin oranları yüksek, şiddetli hiperbilirubinemisi olan yenidoğanlar ABE açısından risk altında olduğundan bu olgularda ET düşünülmelidir

Anahtar Kelimeler:

Yenidoğan, kan değişim transfüzyonu, hiperbilirubinemi, akut bilirubin ensefalopatisi.

Outcomes of rescue exchange transfusion in severe neonatal hyperbilirubinemia

Purpose: Urgent treatment in newborns with severe hyperbilirubinemia is the removal of bilirubin from the body by exchange transfusion (ET) as the main treatment modality. The aim of this study was to evaluate the outcomes of newborns with severe hyperbilirubinemia who underwent ET in two neonatal ıntensive care units (NICUs). Materials and Methods: The clinical data were collected of 28 newborns who had undergone rescue exchange transfusions after hospitalization with a diagnosis of severe hyperbilirubinemia in NICUs of a university hospital and a state hospital. Results: Evaluation was made of 28 newbons with a median serum bilirubin level on admission of 31.2 (20.3-36.8) mg/dL. The leading cause for exchange transfusion was hemolytic jaundice (67.8%), followed by inadequate feeding (14%). The most common cause of hyperbilirubinemia was Rh incompatibility. The reported rate of adverse events associated with exchange transfusion was 71%. The most common complications due to ET were thrombocytopenia and anemia. Four infants died after the ET therapy. Acute bilirubin encephalopathy (ABE) was detected in 39% of the newborns. Serum bilirubin and bilirubin/albumin ratios were found to be high in newborns with ABE. Conclusion: Newborns with severe hyperbilirubinemia, especially when related to hemolytic jaundice, may need rescue ET. As newborns with severe hyperbilirubinemia with a high bilirubin/albumin ratio are at risk of ABE, ET should be considered in these cases

Keywords:

Newborn Newborn, exchange transfusion, hyperbilirubinemia, acute bilirubin encephalopathy,

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