Exchange Transfusion In Newborns

WHAT YOU SHOULD KNOW:

An exchange transfusion (trans-FEW-shun) is done if your baby has blood problems. During this procedure, caregivers replace some of your baby's blood with donor blood. Donor blood comes from the blood bank. Your baby may need this procedure if he has too much jaundice. Jaundice causes the skin or whites of the eyes to have a yellow color. Your baby may need an exchange transfusion if his body is attacking his red blood cells. An exchange transfusion usually lasts about 1 to 2 hours.

CARE AGREEMENT:

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby.

RISKS:

There are risks to having an exchange transfusion. Your baby may get an infection or have bleeding problems. Air bubbles or blood clots could form and cause heart or breathing problems. The exchange transfusion could cause bowel problems in your baby. A tube could poke through the heart or a blood vessel during the procedure, and your baby could go into shock. Your baby could die suddenly during the exchange transfusion. Your baby could get too warm or too cold, or his blood could get too thick or too thin. Without this procedure, your baby may have too much bilirubin in his blood. If this happens, his brain may be damaged.

WHILE YOU ARE HERE:

Before the Exchange Transfusion:

Caregivers will place your baby on a flat bed with a heater over it. Your baby may also have 1 or more of these:

Informed Consent:

• You have the right to understand your baby's health problem. You should understand what tests, treatments, or procedures may be done to treat your baby's problem. Your baby's caregiver should also tell you about the risks and benefits of each treatment.
  
  
• You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your baby. A consent form is a legal paper that gives caregivers permission to do tests, treatments, or procedures. This form should tell you exactly what will be done to your baby. Your baby's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all of your questions have been answered. This way you will understand what may happen to your baby.

Bili Lights:

This is also called phototherapy (foe-toe-THAIR-uh-pee). Caregivers may use bili lights or a lighted blanket to help your baby's jaundice go away. Your baby may wear eye patches while he lies under or on the bili lights. He may wear a tiny diaper or will be naked during this treatment. Caregivers may keep the bili lights on during and after your baby's exchange transfusion.

Blood Tests:

Caregivers will take a sample of your baby's blood to test it before, during, and after the exchange transfusion. "Blood gases" help caregivers know how much oxygen, acids, and carbon dioxide (di-OKS-ide) are in your baby's blood. Other blood tests show caregivers how your baby's blood, heart, and other organs are doing. If your baby has jaundice, caregivers will watch your baby's bilirubin (BIL-e-rew-ben) level. Jaundice is caused by too much bilirubin in the blood.

Heart Monitor:

This is a machine used to see how your baby's heart is handling his health problem. 3 or 5 sticky pads are placed on your baby's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your baby's heartbeat. Caregivers watch this picture to make sure your baby's heart is doing well.

IV:

An IV is a tiny tube placed in your baby's vein. It may be put in your baby's hand, arm, ankle, foot, or head. Your baby's IV may be hooked to a machine that will give your baby fluids and medicine.

NPO:

NPO means "nothing by mouth". Do not give your baby anything to eat or drink if he is NPO. Your baby's IV has sugar in it that feeds him and may make him less hungry. Give your baby a pacifier to suck on if he is fussy or acting hungry. If you are a breast feeding mother, pump your breasts while your baby is NPO. This helps your breasts to make milk even while your baby is not drinking it. Ask caregivers for information about pumping and storing breast milk. Keep your breast milk in a freezer until caregivers tell you that your baby can start drinking it.

Pulse Oximeter (oks-IH-mih-ter):

This is a machine that shows caregivers how much oxygen is in your baby's blood. A cord with a clip or sticky strip is placed on your baby's foot or hand. The machine will sound an alarm if it cannot read the oxygen level or if your baby needs more oxygen.

Restraints:

These are cloth bands used to tie your baby's wrists or ankles to the sides of his bed. These restraints are used to keep your baby from pulling or kicking out any special tubes he may have. Restraints may be used during the procedure and for a short time after it is over. They will be taken off when there is less chance that your baby will pull or kick the tubes out.

Vital Signs:

This may include taking your baby's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your baby's temperature may be taken in his armpit or by a skin probe (small button that is taped to the skin). Caregivers may listen to your baby's heart and lungs by using a stethoscope (STETH-uh-skop). Your baby's blood pressure is measured using a tiny cuff around his arm or leg. Caregivers may measure the blood pressure with a device connected to your baby's UAC. A UAC is also called an "umbilical (um-BILL-ih-kul) artery (R-ter-e) catheter". Caregivers will check your baby's vital signs very often before, during, and after the exchange transfusion.

During the Exchange Transfusion:

• When your baby is ready for the exchange transfusion, caregivers will clean your baby's belly with a special soap. Then they will cover his belly with a clean sheet that has a hole in the middle. The umbilical (um-BILL-ih-kul) cord stump that sticks out of your baby's belly button will show through the hole. Caregivers may put 1 or more IV tubes in your baby's umbilical cord stump. An IV tube that goes into an umbilical vein is called a "UVC" or umbilical venous (V-nus) catheter. An IV tube that goes into the umbilical artery is called a "UAC" or umbilical artery (R-ter-e) catheter. Caregivers will use these tubes to take your baby's blood out and put in healthy, new blood.
  
  
• During the procedure, caregivers slowly remove a small amount of blood from your baby. Then they slowly push the same amount of warm, new blood (from the blood bank) into your baby. They will do this over and over again until your baby has enough new, healthy blood. If your baby has jaundice, an exchange transfusion helps to wash the extra bilirubin (BIL-e-rew-ben) out of your baby's blood. If your baby has polycythemia (blood that is too thick), caregivers may give IV fluid or plasma instead of blood. This helps your baby by making his blood a little thinner. Plasma is the clear part of the blood that does not have red blood cells in it.

After the Exchange Transfusion:

• Your baby will stay on the flat bed with all of his IVs in. Caregivers will do blood tests and will watch your baby to make sure he does not need another exchange transfusion. When caregivers decide that your baby does not need another transfusion, they may remove some of the IVs. They may also choose to leave them in for a while longer. When your baby is ready, caregivers may put him back in his regular bed. If your baby has jaundice, he will continue to lie on or under bili lights and have blood tests done. When his bilirubin level is low enough, caregivers will stop using the bili lights. Caregivers may start to feed milk or formula to your baby if he does not have other serious health problems.
  
  
• If your baby is full term, he may stay in the hospital 1 or 2 days after the procedure. Then your baby may be ready to go home. If your baby has other health problems or is premature (born early), he may need to stay in the hospital longer.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.