Hemodynamic changes during exchange transfusion in early neonatal period
Abstract
Background: Exchange transfusion(ET) has remained the gold standard for rapid lowering of higher bilirubin levels, it is not risk free and mortality rate vary from 0.5 to 3.3%. The present study was carried out to study hemodynamic parameters changes during ET in neonates.
Materials and Methods: 22 neonates who suffered from hyperbilirubinemia and required double volume ET were enrolled in this prospective study. ET was carried out according to standard practice guidelines. Clinical hemodynamic parameters including heart rate, respiratory rate, blood pressure, temperature and ECG, % saturation of oxygen (SpO2) and CVP were monitored continuously before 15 min (pre exchange) during 60-120 min(mid exchange) and after 30 min(post exchange). All data was analysed statistically.
Results: There was significant increase in mean heart rate152.78(19.88),155.12(20.50), mean respiratory rate 46.02(8.87),50.92(6.98) and drop in mean Spo2 91.19(4.17),90.67(4.28) in mid-exchange and post-exchange values respectively as compared to pre exchange values138.72(17.74),36.79(7.58),93.51(3.28) for mean heart rate, respiratory rate and mean SpO2 respectively. There was significant increase in mean diastolic blood pressure values in post-exchange 45.43(13.88) as compared to pre exchange values 41.83(9.80). Mid-exchange value 8.66(2.12) of mean central venous pressure was significantly lower from pre-exchange 10.10(1.92) and post-exchange 9.56(1.98) values. ECG changes did not show any significant changes during ET.
Conclusion: There were significant adverse effects on all hemodynamic clinical parameters. Monitoring of neonate is essential during ET which will prevent complications of ET. Current recommendations for performing ET are based on balance between the risk of encephalopathy and the adverse events related to the procedure holds true.
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References
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