| Autor: |
Mabogunje CA; Cecilia A Mabogunje, Neonatal Unit, Massey Street Children's Hospital, Lagos, Nigeria., Olaifa SM; Cecilia A Mabogunje, Neonatal Unit, Massey Street Children's Hospital, Lagos, Nigeria., Olusanya BO; Cecilia A Mabogunje, Neonatal Unit, Massey Street Children's Hospital, Lagos, Nigeria. |
| Jazyk: |
angličtina |
| Zdroj: |
World journal of clinical pediatrics [World J Clin Pediatr] 2016 May 08; Vol. 5 (2), pp. 182-90. Date of Electronic Publication: 2016 May 08 (Print Publication: 2016). |
| DOI: |
10.5409/wjcp.v5.i2.182 |
| Abstrakt: |
Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion (ET) when the risk or presence of acute bilirubin encephalopathy is established in order to prevent chronic bilirubin encephalopathy or kernicterus. However, the literature is sparse concerning the interval between the time the decision for ET is made and the actual initiation of ET, especially in low- and middle-income countries (LMICs) with significant resource constraints but high rates of ET. This paper explores the various stages and potential delays during this interval in complying with the requirement for immediate ET for the affected infants, based on the available evidence from LMICs. The vital role of intensive phototherapy, efficient laboratory and logistical support, and clinical expertise for ET are highlighted. The challenges in securing informed parental consent, especially on religious grounds, and meeting the financial burden of this emergency procedure to facilitate timely ET are examined. Secondary delays arising from post-treatment bilirubin rebound with intensive phototherapy or ET are also discussed. These potential delays can compromise the effectiveness of ET and should provide additional impetus to curtail avoidable ET in LMICs. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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