Blood replacement in babies with jaundice caused by Increased Bilirubin in the blood

The article is consulted professionally by Specialist I Bui Thi Ha – Pediatrician – Newborn – Pediatrics – Newborn – Share99 Ha Long International Health Hub.

Newborn jaundice caused by indirect bilirubin increase is a common phenomenon. In newborn jaundice increased bilirubin indirectly can be seen 60% in full-month babies and 80% in premature babies. The disease can be mild (jaundice) or severely progressive (pathology jaundice). The disease should be detected early and treated in a timely manner to avoid serious complications, which can result in the child dying or having cerebral palsy for life.

Jaundice occurs early from the 1st – 2nd day after birth: Mainly due to hemolysis, rarely. Common causes are mage and child blood type disagreements, immune hemolysis, G6PD deficiency. Jaundice occurs when the mother has the Rh factor (-), the child is born with the Rh factor (+). When the mother is pregnant, some of the fetal esth blood cells Rh (+) enter rh's bloodstream (-). The mother's body responds by giving birth to anti-Rh antibodies (+). These antibodies enter the body of the fetus, causing hematoma. In addition to jaundice, the child also has anemia, hemorrhage, enlarged liver and enlarged spleen.

Jaundice occurs from the 3rd – 10th day after birth: Often due to umbilical infections, skin infections, sepsis; Polyethemia, blood tumors, serum humps; delay in stool consumption, atrophy of the intestines;

Jaundice lasts more than 14 days: Mainly due to breast milk, babies with liver disease, bile obstruction, congenital insular introsmosis or conversional diseases.

• Transient encephaes: Pediatric patients are poisoned by early, transient Bilirubin increases. Clinical manifestations are babies, sleeping a lot
• Jaundice: As a brain pathology caused by an increase in undocular bilirubin, the course of permanent neurological damage is jaundice. Manifested through 3 stages:
  • Phase 1: Appears in the first days, the child sleeps chickens, reduces muscle entest, sucks poorly, cries;
  • Phase 2: Appearing immediately after birth or in the first week after birth, babies who give up breastfeeding, increased muscle concentration, fever, convulsions, convulsions, or neck and torso, may die during apnea.
  • Phase 3: Appears after 1 week after birth, has symptoms, increased muscle muscle movement, coma, convulsions, visual and auditory abnormalities.

Blood replacement is a procedure that removes part of the hemolysis ureter attached to antibodies and inage antibodies in co-immune hemolysis pathology that increases free bilirubin in the blood and replaces it with donor blood. Blood replacement is also applied in some other cases when bilirubin in the blood rises too high to the threshold that can be neuro toxic.

4.1. Note when changing blood

• It is recommended to check the concentration of Bilirubin in the blood in the child: Jaundice from the first day after birth; jaundice appears from the 2nd day in premature babies under 35 weeks; jaundice to the palms, palms of the feet at any age date;
• Babies should be illuminated before giving blood replacements;
• Evaluation of emergency brain complications due to increased free bilirubin in the blood;

4.2. Blood replacement in dinh

• Clinical: Full-body dark jaundice (less than 1 week), begins to show neurological abnormalities
• Or high blood indirect bilirubin levels > 20mg%, starting to show neurological abnormalities such as separation, poor feeding.

4.3. Contraint of blood replacement

• Hemolysis is unstable;
• Being severely respiratoryly impaired or shocked;
• Umbilical catheter could not be set;
• No proper blood and fresh blood (less than 5 days).

In case of blood replacement, alternative treatments can be applied as continuous 2-side lamps and can be transmitted with Albumin, Phenobacbitan

4.4. Preparation before blood replacement

• Heating beds, tools and resuscitation drugs;
• Have the patient lie on his back, fix his 20s, fast and attach a monitor;
• Preparation of the instrument includes: Umbilical catheter lying tools; blood replacement tools (syringes 10 – 20ml for pumping blood); infusion line sets, blood transfusion sets; ile larmated bags containing blood;
• Blood replacement: Double blood replacement volume; in case of disagreement Rh use whole blood group O, Rh (-) suitable for the mother's blood; In case of ABO disagreement using group O whole blood (or O-deposited red blood cells and freshly frozen plasma AB if there is no new blood), Rh is suitable for mother and child. In addition, it is recommended to take new blood less than 7 days, the blood is warmed at 37 degrees Celsius before changing blood.

4.5 Performing blood replacement techniques

• Medical staff wash their hands, wear robes, wear ermic gloves;
• Coated catheter, wiring and 3 divided with brine;
• Proceed to the lying of the umbilical vein catheter;
• Connect the 3 system divided with the umbilical vein catheter, connecting the 3 dividing blood clots and the bag containing the discharged blood;
• Perform the pull-push technique, avoiding withdrawal or pumping in with strong pressure;
• Blood volume changes per cycle = weight x 5; blood drawn = the amount of blood pumped in; the duration per cycle is 1 – 1.5 minutes;
• After the end of blood replacement, remove the umbilical vein catheter;
• After blood replacement: Continue to shine the lamp, feed the child for 6 hours to avoid the risk of necrotizing enteritis and HCT test, counting thrombophym, Bilirubin, electrolysis, blood glucose.

4.6 Monitoring and handling complications

Follow-up of blood changes in babies with jaundice to promptly detect and handle the following complications:

• Complications associated with umbilical cord catheter;
• Infection from blood clots or by procedure;
• Increase or hypothermia
• Anemia, tinglet reduction
• Disorders of electrolysis, alkaline acidosis, blood glucose;
• Necrotizing enteritis
• Hemolysis due to strong pumping or withdrawal pressure.

Blood replacement is a technique in which severe jaundice is in place in babies when the disease is at risk of neuro intoxication. When treating your baby with this method, it is necessary to follow the instructions of the doctor to ensure the highest therapeutic effect, avoiding the possible conditions.