Crystalloid or colloid for partial exchange transfusion in neonatal polycythemia: a systematic review and meta-analysis.
OBJECTIVE
To determine whether crystalloid solutions are as effective as colloid solutions when a partial exchange transfusion is performed in newborns with polycythemia.


METHODS
We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register of the Cochrane Library (1966-2004). Keywords used were: polycythemia, partial exchange transfusion, hyperviscosity, and limited to newborn. Randomized studies in newborns with polycythemia were selected for evaluation. Outcomes examined were: long-term neurodevelopment; short-term physiological effects; improvement in clinical symptoms; reduction in haematocrit at 4-6 h; haematocrit at 24 h; and frequency of serious complications.


RESULTS
Four randomized controlled clinical trials, including 200 patients in total, with evaluable data, which satisfied our criteria, were found. There were no data on long-term outcomes. There is no reported important difference in short-term physiologic effects. Use of crystalloid was as effective as colloid in both correction of haematological values and reduction of clinical symptoms following partial exchange transfusion.


CONCLUSIONS
Crystalloid solutions are as effective as colloid solutions for partial exchange transfusion. When crystalloid solutions are used for this purpose, there is no risk of transmission of blood-borne diseases, there is no risk of anaphylaxis, they are rapidly and easily available, and are less expensive. The use of crystalloid should become the standard for partial exchange transfusion.
Dempsey
Eugene M
EM
Department of Paediatrics, McGill University Health Center, Montreal, Canada. gene.demsey@sympatico.ca
Barrington
Keith
K
D003102:Colloids; D000077324:Crystalloid Solutions; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007552:Isotonic Solutions; D011086:Polycythemia / Q000628:therapy*; D016896:Treatment Outcome
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions