Get access

Single versus double volume exchange transfusion in jaundiced newborn infants

  • Review
  • Intervention

Authors


Abstract

Background

Double volume exchange transfusion is commonly used in newborns with severe jaundice in order to prevent kernicterus and other toxicity related to hyperbilirubinemia. Most commonly, exchange transfusions are used in infants with rhesus hemolytic disease.

Objectives

To compare the effectiveness of single volume exchange transfusion (SVET) with that of double volume exchange transfusion (DVET) in producing survival without disability and reducing bilirubin levels in newborn infants with severe jaundice.

Search methods

MEDLINE, EMBASE (Excerpta Medica online), The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), SCISEARCH (Science Citation Index), Reference lists from the articles identified in the search of the databases, and from review articles were searched through March 2006. Personal communication with experts in the field was used to identify unpublished data.

Selection criteria

All Randomised and quasi randomised control trials comparing single volume and double volume exchange transfusions in jaundiced newborn infants were included.

Data collection and analysis

Safety and efficacy of single and double volume exchange compared with regards to long term neurodevelopment, reduction in bilirubin levels and other complications during exchange transfusion. Data was evaluated separately with regards to the cause of jaundice. Relative risk (RR) and weighted mean difference (WMD) were calculated for dichotomous and continuous variables respectively. 95% confidence intervals were used and a fixed effects model was assumed.

Main results

Only one study fulfilled the criteria (Amato 1988). 20 full term babies requiring exchange transfusion for hemolytic jaundice due to ABO incompatibility were randomly allocated to receive single or double volume exchange transfusion. Base line characteristics of both groups were similar with regards to birth weight 3260 (SD 390) g vs. 3350 SD (410) g, gestational age 39 (SD 1) week vs. 40 (SD 0.8) week, immediate pre exchange bilirubin level 199 (SD 33) micromol/L vs. 216 (SD 55) micromol/L. Both groups were treated equally apart from the volume of blood used for exchange transfusion. Total bilirubin levels immediately after exchange transfusion were not significantly different in either group. No long term neurodevelopmental outcome was examined in this study.

Authors' conclusions

There was insufficient evidence to support or refute the use of single volume exchange transfusion as opposed to double volume exchange transfusion in jaundiced newborns. A change from the current practice of double volume exchange transfusions for severe jaundice in newborns infant, cannot be recommended on current evidence.

摘要

背景

黃疸嬰兒使用單倍體積與雙倍體積換血治療

為了預防新生兒因為嚴重黃疸造成核黃疸或其它毒性危害,常常會用雙倍體積換血治療。換血治療最常見就是用在因為Rh血型不合引起的溶血疾病。

目標

比較雙倍體積換血和單倍體積換血治療嚴重黃疸的嬰兒,對於無併發症存活率的影響及降低黃疸的效益。

搜尋策略

自2006年三月、從MEDLINE、EMBASE (Excerpta Medica online)、The Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library)、 SCISEARCH (Science Citation Index),及從這些文章引用的文獻,還有與這個領域的專家交換意見收集未發表的資料。

選擇標準

所有比較雙倍體積與單倍體積換血治療黃疸嬰兒的隨機對照試驗及準隨機對照試驗都被涵括。

資料收集與分析

比較雙倍體積與單倍體積換血治療的安全性、效用、長期神經學發展、膽色素下降程度、和輸血中相關的併發症。資料會根據引起黃疸的原因作個別分析。 相對危險因子及加權均數差個別以二元變異數與連續變異數分別計算其風險比與加權均數差。 正確度以95% 信賴區間表示並以固定效應模式分析。

主要結論

只有一個研究符合選擇標準(Amato 1988)。20個足月產的嬰兒隨機分配接受單倍或雙倍體積換血來治療因為ABO血型不合引起的溶血性貧血。這兩群病人的基本資料是相類似的,包括出生體重(3260克,標準差390克 對 3350克, 標準差410克)、出生週數(39周,標準差1周 對 40周, 標準差0.8周)、換血前膽色素值(119毫莫耳/升,標準差33毫莫耳/升 對 216毫莫耳/升,標準差55毫莫耳/升這兩組病人除了換血容積不同外,其他治療都一樣。 治療後的總膽色素值並沒有顯著差異。長期的神經學發展在此研究中未被評估。

作者結論

沒有足夠的證據支持或反對用單倍體積換血代替雙倍體積換血來治療黃疸嬰兒。 因目前的證據不足,無法建議改變目前常使用的雙倍體積換血來治療嚴重黃疸嬰兒的策略。

翻譯人

本摘要由高雄醫學大學附設醫院郭昶宏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

極高的膽色素會對導致腦部損害。 罹患嚴重黃疸的嬰兒可能起因於Rh血型不合、ABO血型不合或不正常抗體所導致的急性溶血。 將患病的嬰兒體內血液移除並以新鮮血庫血取代(換血治療)是常用於治療嚴重黃疸嬰兒的治療方法。換血治療過程中,病嬰一小部份的血被移出,並以等量的新鮮血取代。 傳統上會移除二倍病嬰血量並以同等量新鮮血液取代之。 換血治療已被證實可以減低罹患高膽色素血素症病嬰的腦部傷害。 然而,有些嚴重副作用包括死亡,是與換血治療有相關聯的。隨著換血量的增加,副作用也可能會增加。這篇文獻回顧檢視單倍體積換血是否和雙倍體積換血治療嚴重黃疸嬰兒在降低腦部損害及膽色素值是否同樣有效。只有一個隨機試驗符合選擇標準用於分析。這個研究比較單倍體積換血和雙倍體積換血治療因為ABO血型不合引起黃疸的病嬰。 這個研究發現在換血治療後的膽色素值並沒有顯著差異。這個研究中並沒有著眼於對於長期神經學發展的差異(腦部損害)。依目前的資料,沒有足夠的證據支持或反對用單倍體積換血代替雙倍體積換血來治療黃疸嬰兒。

Plain language summary

Single versus double volume exchange transfusion in jaundiced newborn infants

Extremely high levels of bilirubin (severe jaundice) can lead to brain damage. Severe jaundice in newborns can occur as a result of a variety of causes including rhesus hemolytic disease, ABO incompatibility, atypical antibodies etc. Removal of blood from the affected infant and replacing with fresh blood from the blood bank (exchange transfusion) is used as a treatment for severe jaundice in newborn infants. The affected infant's blood is removed in small portions and equal volume of blood is replaced during exchange transfusion. Traditionally twice the blood volume of baby is removed and the replaced with fresh blood. Exchange transfusion has been shown to reduce brain damage in severely jaundiced babies; however, exchange transfusion is associated with serious adverse events including death. It is likely that the complications of exchange transfusion would increase with amount of blood exchanged. This review was undertaken to examine if single volume (removal of blood equivalent to the blood volume of the baby) is as effective as double volume (removal of twice blood volume of the baby) in reducing the brain damage and bilirubin levels in newborn infants with severe jaundice. Only one randomised trial fulfilled the criteria for inclusion in the analysis. This study compared single and double volume exchange transfusion in jaundice due to ABO hemolytic jaundice. The study found no significant difference in bilirubin levels following exchange. This study did not look at any long term neurodevelopmental outcome (brain damage). Based on the available data, there is insufficient evidence to support or refute the use of single volume exchange transfusion as opposed to double volume exchange transfusion in jaundiced newborns.

Ringkasan bahasa mudah

Pertukaran darah volum tunggal berbanding volum berganda bagi bayi baru lahir yang mengalami jaundis

Paras bilirubin yang amat tinggi (jaundis teruk) boleh menyebabkan kecederaan otak. Jaundis teruk dalam bayi baru lahir boleh berlaku akibat pelbagai sebab termasuk penyakit hemolitik rhesus, ketidakserasian ABO, antibodi atipikal, dll. Pengeluaran darah dari bayi yang terjejas dan penggantian dengan darah segar dari tabung darah (pertukaran darah) digunakan sebagai rawatan untuk jaundis yang teruk bagi bayi baru lahir. Darah bayi yang terlibat dikeluarkan dalam bahagian yang kecil dan volum darah yang sama digantikan semasa pertukaran darah. Secara tradisi, volum darah yang dikeluarkan adalah dua kali ganda volum darah bayi dan digantikan dengan darah segar. Pertukaran darah telah didapati boleh mengurangkan kecederaan otak dalam bayi dengan jaundis teruk; tetapi, ianya dikaitkan dengan peristiwa-peristiwa buruk yang serius termasuk kematian. Komplikasi pertukaran darah berkemungkinan meningkat dengan jumlah darah yang ditukarkan. Kajian semula ini dijalankan untuk memeriksa sama ada pertukaran darah volum tunggal (pengeluaran darah bersamaan dengan volum darah bayi) mempunyai kesan yang sama dengan pertukaran darah volum berganda (pengeluaran darah bersamaan dua kali ganda volum darah bayi) dalam mengurangkan kerosakan otak dan paras bilirubin dalam bayi baru lahir yang mengalami jaundis teruk. Hanya satu kajian rawak yang memenuhi kriteria untuk dimasukkan dalam analisis. Kajian ini membandingkan pertukaran darah volum tunggal dan volum berganda bagi jaundis akibat jaundis hemolitik ABO. Kajian ini mendapati tiada perbezaan signifikan bagi paras bilirubin selepas pertukaran. Kajian ini tidak meneliti kesan perkembangan otak (neurodevelopment) jangka masa panjang (kecederaan otak). Berdasarkan data yang sedia ada, tiada bukti yang mencukupi untuk menyokong atau menolak kegunaan pertukaran darah volum tunggal berbanding volum berganda dalam bayi baru lahir yang mengalami jaundis.

Catatan terjemahan

Diterjemahkan oleh Foo Sook Lee. Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi fslee@pmc.edu.my. Disunting oleh Tan May Loong (Penang Medical College; mltan@pmc.edu.my).

Get access to the full text of this article

Ancillary