Blood Swap Procedure's Significance in Kernicterus Prevention
Kernicterus: A Serious Condition Affecting Newborns
Kernicterus is a rare but serious condition that can affect newborns, particularly males. This condition is caused by dangerously high levels of unconjugated bilirubin in the blood, a waste product produced during the breakdown of red blood cells, which crosses the blood-brain barrier and causes permanent brain damage.
Causes and Risk Factors for Kernicterus
The most common cause of kernicterus is hemolytic disease of the newborn due to blood group incompatibility. Prematurity, excessive bilirubin production, congenital hemolytic anemias, genetic disorders affecting bilirubin metabolism, sepsis or infection, excessive administration of certain drugs, and early appearance of jaundice within the first 24 hours of life are other factors that increase the risk of kernicterus.
Additional Risk Factors
Very high serum indirect (unconjugated) bilirubin levels and delayed recognition and treatment of jaundice significantly raise the likelihood of bilirubin crossing into the brain.
Preventing Kernicterus
Kernicterus is preventable with prompt recognition and management of hyperbilirubinemia. Exchange transfusion, a procedure in which a baby's blood is removed and replaced with donor's blood, is recommended when phototherapy is not effective or when bilirubin levels are extremely high.
Exchange Transfusion
During an exchange transfusion, a newborn's blood is removed in small amounts and replaced with donor blood. This helps prevent kernicterus by removing bilirubin, antibodies, and defective red blood cells from a baby's blood.
Acute Bilirubin Encephalopathy
Acute bilirubin encephalopathy occurs in approximately 1 out of 10,000 newborns. Symptoms include irritability, lethargy, poor feeding, high-pitched crying, changes in muscle tone, and arching of the back or neck.
Phototherapy
Phototherapy is the first and most common treatment for hyperbilirubinemia. It converts bilirubin into a form that can be easily removed from the body.
Conclusion
Kernicterus primarily results from excess unconjugated bilirubin due to hemolysis and poor bilirubin clearance in newborns, especially in premature infants or those with underlying hemolytic or metabolic conditions. Elevated bilirubin levels above a critical threshold and early-onset jaundice are key risk factors that need urgent medical monitoring and intervention to prevent permanent neurological damage.
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