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Exchange transfusions in neonatal sepsis.

R Dalvi1, S Rao, J Rangnekar

  • 1Department of Neonatology, LTM Medical College, Bombay.

Indian Pediatrics
|January 1, 1991
PubMed
Summary

Therapeutic exchange transfusion (ET) effectively treated severe neonatal sepsis in 53 infants, with a 77.4% survival rate. This safe procedure improved clinical features and resolved sclerema, offering a viable treatment option for neonates.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Hematology

Background:

  • Severe neonatal sepsis is a critical condition with high mortality.
  • Unresponsive sepsis cases require advanced therapeutic interventions.
  • Sclerema is a common manifestation in neonates with severe sepsis.

Purpose of the Study:

  • To evaluate the efficacy and safety of therapeutic exchange transfusion (ET) for severe or unresponsive neonatal sepsis.
  • To assess the impact of ET on clinical features, including sclerema resolution.
  • To determine survival rates in neonates undergoing ET for sepsis, considering birth weight.

Main Methods:

  • A cohort of 53 neonates with severe sepsis received exchange transfusions (ET) using 170 ml/kg of fresh citrated blood.
  • The ET procedure was repeated up to four times based on clinical response.
  • Outcomes were assessed by resolution of sclerema, clinical improvement, and survival rates; neurologic complications were analyzed via multiple regression.

Main Results:

  • The mean recovery time post-ET was 19.6 ± 12.4 hours.
  • Overall survival rate was 77.4%; survival for low birth-weight (LBW) and non-LBW infants was 73.6% and 68.2%, respectively (not statistically significant).
  • Neurologic problems were associated with a poorer prognosis despite ET; no significant complications from ET were observed.

Conclusions:

  • Therapeutic exchange transfusion (ET) is an effective and safe treatment for severe neonatal sepsis.
  • ET can lead to clinical improvement and resolution of sclerema in neonates.
  • While ET improves survival, associated neurologic issues remain a significant factor impacting outcomes.

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