To study the outcome of exchange transfusion in severe neonatal sepsis in neonates admitted in NICU at Dr. Bhim Rao Ambedkar memorial hospital, Raipur, Chhattisgarh, India

Background: Sepsis is one of the most common causes of neonatal mortality and morbidity.Immaturity of the immune system, newborn infants are highly susceptible to systemic infection.Blood exchange transfusion in severe neonatal sepsis remove bacteria, bacterial toxins, andcirculating pro-inflammatory cytokines, improve perfusion and tissue oxygenation, correct theplasma coagulation system and enhance immunological defence mechanisms. Material andmethods: This is a hospital-based, time-bound, analytical observational study conducted fromJanuary 2019 to December 2019 in the NICU of Dr. B.R.A.M. Hospital & Pt. J. N. M. Medical College,Raipur, Chhattisgarh, India. The data was collected in pre-designed proforma, entered in MicrosoftExcel and analysis was done using SSPS v 22.0. Result: About 42 neonates were diagnosed withsevere neonatal severe. Of which 23 (54.76%) were preterm, 42.24% were term neonates.Maximum 22 (52.38%) were VLBW, 4.76% were LBW and 19.05% were with normal birth weight. Inthe study two-third of 28 (66.67%) were outborn and one third were inborn. In the present studymajority of 30 (71.43%) had EOS and 12 (28.57%) had LOS. In our study out of 42 study subjects24 (57.14%) died and 18 (42.86%) were discharged after blood exchange transfusion. Of those whodied 15 (62.5%) were preterm and of those discharged 10 (55.6%) were term neonates (p=0.349).Outborn neonates more died as compare to inborn though this was also not significant (p=0.133).Conclusion: significant reduction of mortality in patients who underwent exchange transfusion,together with the no adverse effects observed, suggest that this procedure should be considered forthe treatment of neonates with severe sepsis.

Serum Endocan, Neuron-Specific Enolase and Ischemia-Modified Albumin Levels in Newborns with Partial Blood Exchange Transfusion

Background:: Hyperviscosity of blood secondary to polycythemia results in increased resistance to blood flow and decrease in delivery of oxygen. Objective:: To evaluate whether serum endocan, NSE and IMA levels can be compared in terms of endothelial injury/ dysfunction and neuronal damage in term neonates with polycythemia who underwent PET. Methods:: 38 symptomatic polycythemic newborns having PET and 38 healthy newborns were included in the study. Blood samples for endocan, NSE and IMA were taken at only postnatal 24 hours of age in the control group and in polycytemia group just before PET, at 24 and 72 hours after PET. Results:: The polycythemia group had higher serum endocan(1073,4 ± 644,8 vs. 378,8 ± 95,9ng/ml; p<0.05), IMA(1,32 ± 0,34 vs.0,601 ± 0,095absorbance unit; p<0.05) and NSE(44,7 ± 4,3 vs. 26,91 ± 7,12μg/l; p<0.05) levels than control group before the PET procedure. At 24 hours after PET, IMA(0,656 ± 0,07 vs. 0,601 ± 0,095absorbance unit; p<0.05) and endocan(510,9 ± 228,6 vs. 378,8 ± 95,9ng/ml; p<0.05) levels were closer to the control group, being still statistically significant higher. NSE levels decreased to control group levels having no difference between the PET and control groups at 24 hours after PET (28,98 ± 6,5 vs. 26,91 ± 7,12μg/l; p>0.05). At 72 hours after PET the polycythemia and control groups did not differ statistically for IMA, endocan and NSE levels (p>0.05). Conclusion:: Serum endocan and IMA levels can be used as a biomarker for endothelial damage / dysfunction and tissue hypoxia in infants with symptomatic polycytemia.

Multidrug Resistant Transfusion Vivax Malaria

A 17-day-old premature baby girl had received a blood exchange transfusion because of hyperbilirubinemia and got another blood transfusion because of severe anemia on day 45. The diagnosis of transfusion vivax malaria was made when she had severe anemia again on day 78. The most predominant clinical signs were fever, anemia, hepatosplenomegaly, and thrombocytopenia. Treatment with chloroquine 25 mg base/kg BW showed resistance at RIII level on a 7 -day follow up. She was retreated. with quinine 10 mg salt/age in month divided in 3 doses/day for 7 days. lt also showed resistance at late RI level on day-30. Then she was retreated with quinine 15 mg salt/age in month divided in 3 doses/day for 7 days and still showed resistance at late Rl level on day 32. Finally she was treated with quinine 10 mg salt/kg BW /dose, tid for 7 days which was effective. During the course of treatment, no adverse reactions were found clinically. This malaria case was transfusion vivax malaria resistant to choloroquine at R III level and to quinine at late RI level. Quinine 10 mg salt/BW I dose tid for 7 days was effective and safe for infants.

Whole blood exchange transfusion as a promising treatment of aluminium phosphide poisoning

A 37-year-old male was referred to us about one hour after deliberate ingestion of two 3-gram aluminium phosphide (ALP) tablets. Three hours after admission, his blood pressure dropped to 85/55 mmHg, his heart rate increased to 120 bpm, O2 saturation dropped to 82 %, and the electrocardiogram showed junctional rhythm. We started whole blood exchange, and gross haematuria and jaundice ensued. However, his blood pressure increased, arrhythmia resolved itself, and he was extubated two days after the transfusion was completed. He was sent home seven days after admission completely symptom-free. We believe this treatment may be successfully applied in ALP-poisoned patients.