0165

AN AUTOMATED PERIPHERAL TWO-SITE METHOD FOR NEONATAL EXCHANGE TRANSFUSION IN CHINA

Zhu XY, Huang HW, Zheng LP, Huang RD

Maternal and Child Health Hospital, Zhuhai, Guangdong, China

 

Objective: Automated exchange transfusion (ET) has been reported abroad, but not yet in China. To overcome the disadvantages of conventional "push-pull" method, an automated peripheral two-site method with handiness and fluency for neonatal ET was developed.

Methods: 9 infants of severe hyperbilirubinemia with serum bilirubin (SB) >30 mg/dl (8 for G-6-PD deficiency, 1 for Rh hemolysis) were in this group. The 24G in-dwelling cannula with Y adapter was inserted into peripheral vein for blood-in or artery for blood-out. The artery blood flowed into a measuring cylinder naturally through a drainage tube with a controller keeping a flow rate 4ml/min, which also received continually a bypass heparin solution through a infusion pump B at a 30ml/h rate for fear of clotting and blocking in the drainage tube. Simultaneously the citrated blood was replaced through a pump A at a rate equal to blood-out rate. The whole procedure no longer handed needed "push-pull" action, but proceeded automatically in a close loop. So it became simpler, safer and easier.

Results: The monitored vital signs (blood pressure, heart rate, etc) in ET were normal and stable. The mean spent time was 2.5 hours. Compared with pre-exchanges, the mean SB declined by 45.6% (523.8μmol/L284.8μmol/L), and Hb rose by 58.6% (87g/L138g/L). After exchanges only 3 had mild complications, and no infections and necrotizing enterocolitis occurred. The follow-up in half a year showed all normally in growth and development.

Conclusion: Our automated ET was superior to conventional one in handling and effects with a little different setting from abroad. It could be adopted in most hospitals at different levels. Still it should be avoided to broaden the ET indications at will and cause an "over-therapy".