Adoption of the American Academy of Pediatrics’ neonatal hyperbilirubinemia guidelines and its effect on blood exchange transfusion rate in a tertiary care center in Amman, Jordan

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Al-Lawama,Manar ; Al-Rimawi,Eman ; Al-Shibi,Rawan ; Badran,Eman (2018)
  • Publisher: Dove Press
  • Journal: Journal of Blood Medicine (issn: 1179-2736)
  • Related identifiers: doi: 10.2147/JBM.S162191
  • Subject: Exchange transfusion | Hyperbilirubinemia | Jordan | Diseases of the blood and blood-forming organs | Guidelines | Neonate | RC633-647.5 | Journal of Blood Medicine

Manar Al-Lawama, Eman Al-Rimawi, Rawan Al-Shibi, Eman Badran Department of Pediatrics, The University of Jordan, School of Medicine, Amman, Jordan Introduction: Severe neonatal hyperbilirubinemia can cause mortality and serious morbidities. When phototherapy fails, neonates with severe hyperbilirubinemia should undergo double volume blood exchange transfusion (BET). As this procedure carries a significant risk of mortality and morbidity, adopting guidelines for the treatment of neonatal hyperbilirubinemia is critical to avoid hyperbilirubinemia toxicity and also the complication of an unindicated procedure. Methods: This study investigated the causes, complications, and trend of BET rate in our unit over a 13-year period. The medical charts and laboratory databases of all infants who underwent BET in Jordan University Hospital between 2003 and 2015 were retrospectively reviewed. Results: The rate of exchange cases decreased significantly after adopting the guidelines of American Academy of Pediatrics (P<0.0001). Most neonates were term newborns (69%). Average birth weight was 2,800 g. The most common causes of exchange transfusion were non-hemolytic conditions. Late prematurity alone accounted for 20% of the cases. Thrombocytopenia was the most commonly encountered complication (33%). Chronic neurological complications were seen in 12% of those who were followed for >12 months of age. Conclusions: This study showed a clear decline in the rate of BET after implementing the guidelines of American Academy of Pediatrics. In addition to improving the strategies for the identification and follow-up of at-risk newborns, we should intensify our efforts to prevent the progression of neonatal hyperbilirubinemia to the exchange level by enhancing parents’ ­awareness of this potentially harmful neonatal condition. Keywords: neonate, exchange transfusion, hyperbilirubinemia, guidelines, Jordan
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