Facility-based constraints to exchange transfusions for neonatal hyperbilirubinemia in resource-limited settings

Area of Science:

• Neonatal Medicine
• Pediatric Hematology
• Public Health in LMICs

Background:

• Severe neonatal hyperbilirubinemia poses a risk of acute and chronic bilirubin encephalopathy.
• Clinical guidelines recommend immediate exchange transfusion (ET) to prevent kernicterus.
• Limited data exists on the interval between ET decision and initiation, particularly in low- and middle-income countries (LMICs).

Purpose of the Study:

• To explore potential delays in initiating exchange transfusion (ET) for severe neonatal hyperbilirubinemia in LMICs.
• To identify factors contributing to delays in ET procedures.
• To emphasize the need for timely intervention to prevent kernicterus.

Main Methods:

• Review of available evidence from LMICs concerning the ET process.
• Analysis of stages and potential delays in ET initiation.
• Examination of resource constraints and challenges in LMICs.

Main Results:

• Delays in ET initiation are influenced by factors including intensive phototherapy, laboratory/logistical support, and clinical expertise.
• Challenges in obtaining informed parental consent (religious objections) and financial burdens impede timely ET.
• Secondary delays can occur due to post-treatment bilirubin rebound.

Conclusions:

• Timely exchange transfusion (ET) is critical for managing severe neonatal hyperbilirubinemia and preventing kernicterus.
• Resource limitations and socio-cultural factors in LMICs significantly contribute to ET delays.
• Addressing these delays is essential to enhance the effectiveness of ET and reduce avoidable cases of kernicterus.