What is involved with an exchange transfusion
An exchange transfusion may be recommended for the baby if the bilirubin levels (measured by blood tests) become extremely high. This could be because:
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The bilirubin levels continue to rise, despite the use of double phototherapy lights. |
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The baby is very ill and the levels are escalating at a very rapid rate. |
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The baby is found to have very high bilirubin levels already. |
An exchange blood transfusion essentially involves giving the baby fresh blood and taking away the baby's blood that contains the high levels of bilirubin. This 'dilutes' the level of bilirubin in the baby's system. An exchange transfusion (or 'ET') is aimed at preventing the complication of brain damage (or 'kernicterus') that can result from extremely high bilirubin levels.
Professional opinions can vary as to the level of bilirubin in the blood that must be reached before an exchange transfusion is recommended. For term babies (born after 37 weeks) the level is often in the vicinity of about 340 imol / litre, with lower levels for premature babies. The levels may also be lower if the baby is very ill or is on certain medications.
What is involved with an exchange transfusion? An exchange transfusion needs to be carried out in the neonatal intensive care nursery (if the baby is not already there). The baby's heart rate, breathing rate, temperature and blood pressure need to be monitored continuously with monitoring machines during the transfusion and the baby is usually placed in an
incubator or on a special open bed with an overhead heater.
The baby may need to have their stomach emptied by placing a
nasogastric tube down their nose to their stomach. This will probably be left in place until the transfusion is completed.