A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited...

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Public Health

Background:

• Late presentation and suboptimal phototherapy lead to high rates of avoidable exchange transfusions (ETs) in low- and middle-income countries.
• Systemic limitations in providing timely ETs necessitate resource optimization and treatment triage for infants at risk of kernicterus.

Purpose of the Study:

• To propose a practical priority-setting model for exchange transfusions (ETs) in term and near-term infants after 48 hours of life.
• To aid in managing infants at risk of kernicterus, particularly in resource-limited settings.

Main Methods:

• The model integrates plasma/serum bilirubin estimation.
• It incorporates clinical signs of acute bilirubin encephalopathy.
• It considers neurotoxicity risk factors identified from existing literature.

Main Results:

• The proposed model offers a structured approach to triage infants requiring ETs.
• It aims to predict kernicterus risk more effectively based on combined clinical and laboratory data.
• Evidence-based risk stratification guides resource allocation for timely interventions.

Conclusions:

• This model provides a framework for optimizing ET resource allocation in neonatal care.
• It addresses the challenge of avoidable kernicterus by prioritizing infants most at risk.
• Implementation can improve outcomes for newborns in resource-constrained environments.