Pediatric emergency medicine trisk 0893 0893
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in patients with conjugated hyperbilirubinemia because it can cause a
discoloration of the skin, or “bronze baby syndrome.”
Exchange Transfusion
Exchange transfusion is the most rapid method for lowering serum bilirubin.
Recommended TSB levels for exchange transfusion are based mainly on the goal
of avoiding reaching levels at which kernicterus has been reported. Indications for
exchange transfusion as recommended by the AAP Subcommittee on
Hyperbilirubinemia are shown in Figure 45.2 .
Exchange transfusions should be performed in consultation with a
neonatologist: fresh, irradiated, reconstituted whole blood is infused through an
umbilical vein catheter while the neonate’s blood is withdrawn through an
umbilical artery catheter. During this procedure, the neonate’s partially
hemolyzed and antibody-coated RBCs are replaced with uncoated donor RBCs
that lack the sensitizing antigen. Complications may impart significant morbidity,
and include electrolyte disturbances, infection, and further hemolysis.
