Exchange Transfusion In Newborns

WHAT YOU SHOULD KNOW:

An exchange transfusion is a procedure to give your newborn baby donated blood. Your baby may need this procedure if he is jaundiced or has a blood disorder such as Rh incompatibility or sickle cell anemia.

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:

An exchange transfusion may cause your baby to bleed or get an infection. Air bubbles or blood clots could form and cause heart or breathing problems. The exchange transfusion could cause bowel problems in your baby. 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 high levels bilirubin in his blood that may cause brain damage.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

NPO:

This means that your baby will get nothing to drink by mouth. 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 breastfeeding, 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.

Bili lights:

Caregivers may use bili lights (phototherapy) or a lighted blanket to help decrease your baby's jaundice. 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 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 level. Jaundice is caused by too much bilirubin in the blood.

Heart monitor:

This is also called an ECG, or electrocardiogram. Sticky pads are placed on the chest or other parts of your child's body. Each pad has a wire that is hooked to a TV-type screen. This allows caregivers to see a tracing (picture) of your child's heartbeat. Caregivers will watch the tracing closely during your child's procedure. The heart monitor helps caregivers make sure your child is handling the procedure well.

An IV

is a small tube placed in your child's vein that is used to give him medicine or liquids.

Vital signs:

Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

Pulse oximeter:

A pulse oximeter is a device that measures the amount of oxygen in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your child's oxygen level is low or cannot be read.

During the procedure:

  • Caregivers will place your baby on a flat bed with a heater over it. They will cover your baby's abdomen with a clean sheet that has a hole in the middle. 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 umbilical venous catheter (UVC). An IV tube that goes into the umbilical artery is called an umbilical artery catheter (UAC). 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 donor blood 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 remove bilirubin 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 procedure:

  • 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. 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. If your baby has other health problems or is premature, he may need to stay in the hospital longer.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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