Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study.
10.1097/CM9.0000000000001962
- Author:
Meng ZHANG
1
;
Yang HE
1
;
Jun TANG
1
;
Wenbin DONG
2
;
Yong ZHANG
3
;
Benjin ZHANG
4
;
Hong WAN
5
;
Quanmin DENG
6
;
Lirong GUAN
7
;
Bin XIA
1
;
Zhong CHEN
1
;
Min GE
1
;
Jing ZHAO
1
;
Wenxing LI
1
;
Jingjun PEI
1
;
Yi QU
1
;
Dezhi MU
1
Author Information
1. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
2. Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646099, China.
3. Department of Pediatrics, Sichuan Maternal and Child Health Hospital, Chengdu, Sichuan 610045, China.
4. Department of Pediatrics, Dazhou Central Hospital, Dazhou, Sichuan 635000, China.
5. Department of Pediatrics, Leshan Maternal and Child Health Hospital, Leshan, Sichuan 614000, China.
6. Department of Pediatrics, People's Hospital of Deyang, Deyang, Sichuan 618000, China.
7. Department of Pediatrics, Mianyang Central Hospital, Mianyang, Sichuan 621000, China.
- Publication Type:Multicenter Study
- MeSH:
Child, Preschool;
Exchange Transfusion, Whole Blood/adverse effects*;
Humans;
Hyperbilirubinemia, Neonatal/therapy*;
Infant;
Infant, Newborn;
Kernicterus/therapy*;
Phototherapy/methods*;
Retrospective Studies
- From:
Chinese Medical Journal
2022;135(5):598-605
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.
METHODS:This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years.
RESULTS:A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group.
CONCLUSIONS:In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
