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

Journal of Perinatology volume 36, pages 338–341 (2016)Cite this article

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Abstract

Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

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Acknowledgements

We received valuable comments from Michael Kaplan, Thomas Newman and Tinuade Ogunlesi on an earlier draft of this manuscript. However, we alone take responsibility for the views expressed in this paper.

Author contributions

BOO conceived and designed the study and drafted the manuscript with inputs from IFI, TMS, and RPW. All authors reviewed and approved the final version before submission.

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Authors and Affiliations

  1. Centre for Healthy Start Initiative, Lagos, Nigeria

    B O Olusanya

  2. Department of Pediatrics, Cairo University, Cairo, Egypt

    I F Iskander

  3. Department of Pediatrics, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA

    T M Slusher

  4. Department of Pediatrics, University of Washington, Seattle, WA, USA

    R P Wennberg

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  1. B O Olusanya
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  2. I F Iskander
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  3. T M Slusher
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  4. R P Wennberg
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Correspondence to B O Olusanya.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Olusanya, B., Iskander, I., Slusher, T. et al. A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings. J Perinatol 36, 338–341 (2016). https://doi.org/10.1038/jp.2016.25

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