title: A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.
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.
authors.affiliation: Centre for Healthy Start Initiative, Lagos, Nigeria.
authors.forename: B O
authors.initials: BO
authors.lastname: Olusanya
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt.
authors.forename: I F
authors.initials: IF
authors.lastname: Iskander
authors.affiliation: Hennepin County Medical Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Slusher
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Wennberg
mesh_terms: D001663:Bilirubin / Q000032:analysis; D020000:Decision Support Systems, Clinical; D003906:Developing Countries; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007231:Infant, Newborn; D007647:Kernicterus / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D017146:Models, Organizational; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D010346:Patient Care Management / Q000379:methods / Q000458:organization & administration; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D061665:Time-to-Treatment / Q000458:organization & administration
chemical_list: D001663:Bilirubin