Exchange transfusion Pediatrics 2004

1. Graph to predict the risk of subsequently developing a bilirubin level > 95th percentile Bhutani, Pediatrics 1999 2840 well newborns > 36 wk and BW > 2000 g, or > 35 wk and BW > 2500 g (39.5% risk) (12.9% risk) (2.3% risk) (0 % risk) Phototherapy Pediatrics 2004 • Risk factors for brain toxicity: • Isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis • Albumin < 3.0 g/dl (phototherapy) • Indication for IVIG(0.5 g/kg over 2 hours q 12 hours): Isoimmune hemolytic disease with a total serum bilirubin level • rising in spite of intensive phototherapy (triple bank, with aluminum foil on other side) • or within 2–3 mg/dL (34–51 μmol/L) of exchange level • Immediate exchange transfusion recommended • If infant shows signs of acute bilirubin encephalopathy (hypertonia, arching, retrocollis, opisthotonos, fever, high pitch cry) or • If total bilirubin > 5 mg/dl (85 micromol/L) above the line • For readmitted infants, if the bilirubin level is above the exchange level, repeat bilirubin measurement every 2 to 3 hours and consider exchange if the bilirubin remains above the levels indicated after intensive phototherapy for 6 hours • Additional factor:Bilirubin/Albumin ratio 8, 7.2 and 6.8 mg/g (low, medium and high risk level on the curve, respectively) Exchange transfusion Pediatrics 2004 LPB 1/8/06

2. CASHORE, Clin Perinatol 2000 M J Maisels, J F Watchko, Arch Dis Child 2003 M J Maisels, J F Watchko, Arch Dis Child 2003