Contents Chapter Topic Page Neonatology Respiratory Cardiology
Contents Chapter Topic Page Neonatology Respiratory Cardiology
Contents Chapter Topic Page Neonatology Respiratory Cardiology
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Exchange Transfusion (ET) for Neonatal Jaundice<br />
Purpose<br />
1. To lower the serum bilirubin level and reduce the risk of brain damage and kernicterus.<br />
2. To remove the infants’ sensitised red blood cells and the circulating antibodies and reduce<br />
the degree of red cell destruction.<br />
3. To control the blood volume and relieve potential heart failure..<br />
Preparation of infant<br />
a. Ensure pulse, temperature and respiration are stabilised and maintained.<br />
b. Continue feeding the child and omit only the LAST feed before ET. If needed, empty gastric<br />
content by doing NG aspiration before ET.<br />
c. Proper restraint.<br />
d. Check resuscitation equipment.<br />
e. Set a peripheral IV line.<br />
f. Get a signed informed consent from parent (mortality from ET is 1%).<br />
Grouping of Blood to be used<br />
Rh isoimmunisation- ABO compatible, Rh negative<br />
Other conditions - X match with baby and mother's blood<br />
Emergency - 'O' Rh negative<br />
Fresh whole blood collected in citrate phosphate dextrose ( CPD)<br />
Fresh blood not more than 24 hours old for sick or hydropic infants<br />
Not more than 48 hours (definitely not > 5 days) for other neonates.<br />
Procedure<br />
1. Nurse to assist.<br />
2. Connect baby to cardiac monitor if available.<br />
3. Nurse checks the baseline observations (either via monitor or manually) and record down<br />
on the neonatal exchange blood transfusion sheet. The following observations are recorded<br />
every 15 minutes; apex beat, respirations, colour, tone and behaviour. Dextrostix is to be<br />
done hourly,<br />
4. Doctor performs the ET (See Protocol). At the same time the Nurse keeps a record of apex<br />
beat, condition of baby and the amount of blood given or withdrawn. The whole process<br />
takes at least 90 minutes.<br />
5. Doctor to scrub, gown and mask.<br />
6. Drape the umbilical area.<br />
7. Cannulate the umbilical vein to depth NOT > 5-7cm.<br />
8. Aliquot for removal and replacement : < 2kg - 5 mls<br />
2 to 3 kg - 10 mls<br />
> 3kg - 20 mls<br />
Alternatively blood can be replaced as a continuous infusion into a large vein while removing<br />
blood from an arterial catheter. In smaller infant pumps delivering 120mls an hour allowing 10<br />
ml of blood to be removed every 5 mins can be used. Higher rates will be necessary for bigger<br />
infants. .<br />
Points to note<br />
a. Volume of blood to exchange 160mls/kg body weight. Pre-warm blood if possible.
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