İndirekt Hiperbilirubinemide Exchange Transfüzyon Uygulanması: Tek Merkez Deneyimi

Amaç: Hiperbilirubinemi yenidoğan bebeklerde sık görülen bir klinik durum ve bilirubin ensefalopatisi günümüzde hala önemli bir sağlık sorunu olmaya devam etmektedir. Bilirubin endişesinin azalması ve etyolojik değerlendirmelerin yeterince yapılamaması kernikterus gibi ciddi sorunlara yol açmaktadır. Bu çalışmada, bir yıllık sürede indirekt hiperbilirubinemi nedeni ile exchange transfüzyon yapılan hastalarda, bilirubin ensefalopatisi gelişimi ve etiyolojik nedenleri değerlendirilmiştir. Yöntem: Eylül 2020-Ağustos 2021 tarihleri arasında Neonatoloji kliniğine indirek hiperbilirubinemi nedeni ile yatan ve kan değişimi uygulanan yenidoğanlar retrospektif olarak incelendi. Demografik veriler, laboratuvar parametreleri, kan değişimine bağlı komplikasyonların gelişme sıklığı araştırıldı. Bulgular: Çalışmaya %61.3(38)’ü erkek, %38.7(24)’ü kız olmak üzere 62 bebek alındı. Hastaların %53.2(33)’ü sezaryen ile doğurtulmuştu. Ortalama gebelik yaşı median 38(36-41) hafta olup, doğum ağırlığı ortalama 3063±478 gram bulundu. Hastaların ortalama başvuru yaşı median 5 (1-22) gün olarak bulundu. Olguların etyolojik değerlendirilmesinde %27.4(44)’ünde Rh uyuşmazlığı, %50(31)’inde ABO uyuşmazlığı, %46.8(29)’unda Subgrup uyuşmazlıklarının olduğu görüldü. Hastaların %33.8(21)’inde birden fazla uyuşmazlık tespit edildi. Olguların %21(13)’ünde Glukoz 6 fosfat dehidrogenaz enzim eksikliği saptandı. Hastaların %4.8(3)’ünde etyolojik bir neden bulunamadı. Sonuç: İndirek hiperbilirubinemi ve buna bağlı bilirubin ensefalopatisi halen ciddi bir sorun olmaya devam etmekte ve bu nedenle de exchange transfüzyon uygulanması gerekebilmektedir. İndirek hiperbilirubinemiye bağlı ciddi morbidite ve hatta mortalitelerin azaltılması açısından bilirubin izlemi yakından yapılmalı ve etyolojik değerlendirmeler ile riskli bebekler önceden tespit edilmelidir.

Anahtar Kelimeler:

İndirek Hiperbilirubinemi, Kan değişimi, Bilirubin ensefalopatisi

Exchange Transfusion in Indirect Hyperbilirubinemia: A Single Center Experience

Objective: Hyperbilirubinemia is a common clinical condition in newborn infants, and bilirubin encephalopathy remains an important health problem today. Decreased bilirubin anxiety and inadequate etiological evaluations lead to serious problems such as kernicterus. In this study, the development of bilirubin encephalopathy and its etiological causes were evaluated in patients who received exchange transfusion due to indirect hyperbilirubinemia for a period of one year. Methods: Newborns admitted to the Neonatology clinic between September 2020 and August 2021 due to indirect hyperbilirubinemia and undergoing exchange transfusion were analyzed retrospectively. Demographic data, laboratory parameters, and incidence of complications related to exchange transfusion were investigated. Results: A total of 62 infants, 61.3%(38) boys and 38.7%(24) girls, were included in the study. 53.2%(33) of the patients were delivered by cesarean section. Mean gestational age was 38(36-41) weeks and mean birth weight was 3063±478 grams. The median age at presentation was found to be 5 (1-22) days. In the etiological evaluation of the cases, 27.4%(44) Rh incompatibility, 50%(31) ABO incompatibility, 46.8%(29) Subgroup incompatibility were observed. More than one discrepancy was detected in 33.8%(21) of the patients. Glucose 6 phosphate dehydrogenase enzyme deficiency was detected in 21% (13) of the cases. No etiological cause was found in 4.8%(3) of the patients. Conclusion: Indirect hyperbilirubinemia and related bilirubin encephalopathy still remain a serious problem and therefore exchange transfusion may be required. In order to reduce serious morbidity and even mortality due to indirect hyperbilirubinemia, bilirubin monitoring should be done closely and risky babies should be determined in advance with etiological evaluations.

Keywords:

Indirect Hyperbilirubinemia, Exchange transfusion, Bilirubin encephalopathy,

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