Neonatal Exchange Transfusion for Hyperbilirubinemia

 

Criteria for Exchange Transfusion

 

Evaluation of Neonate for Exchange Transfusion

Finding	Monitor Patient	Consider Exchange	Exchange
maternal anti-D antibody titer	< 1:64	>= 1:64
cord blood hemoglobin	> 14 g/dL	12-14 g/dL	< 12 g/dL
cord blood bilirubin	< 4 mg/dL	4-5 mg/dL	> 5 mg/dL
newborn capillary blood hemoglobin	> 12 g/dL	< 12 g/dL	< 12 g/dL and decreasing in first 24 hours

 

 

Bilirubin Values Indicating Need for Exchange Transfusion in Newborn

Birthweight in Grams	Uncomplicated	Complicated
< 1250	13 mg/dL	10 mg/dL
1250-1499	15	13
1500-1999	17	15
2000-2500	18	17
> 2500	20	18

 

where

• conversion factor of bilirubin from mg/dL to mmol/L is multiplication by 17.1

 

Complicated Newborn Condition includes:

(1) 5 minute Apgar score < 3

(2) PaO2 < 40 torr for 1 hour

(3) pH < 7.15 for 1 hour

(4) rectal temperature <= 35 °C

(5) serum albumin <= 2.5 g/dL

(6) signs of CNS deterioration

(7) proven sepsis

(8) proven meningitis

(9) hemolytic anemia

(10) birth weight < 1000 grams

 

Volume to Exchange

 

The blood volume of a full-term infant is about 85 mL / kg.

 

The volume of whole blood required for a two-volume exchange =

= ((baby's weight in kilograms) * 85 * 2) mL

 

If packed red cells and FFP are used for the exchange and if the target hematocrit is 50%, then:

 

volume of blood to exchange = X = ((baby's weight in kilograms) * 85 * 2) mL

 

volume of red cells needed = Y = (X / 2)

 

volume of packed red cells needed = Z = (Y / 0.7)

 

volume of FFP needed = (X - Z)

 

Be sure to keep the donor blood mixed during the exchange to prevent red cells from settling out.