Exchange Transfusion-To do or Not to do for Neonatal Hyperbilirubinemia?

Author(s): Lajos Lakatos

Exchange transfusion for the treatment of neonatal hyperbilirubinemia is frequenly used also in the low- and middle-income countries. This unique intervention in the neonatal period is rather agressive and too expensive method as a therapy of a generally harmless disease. In neonates the chelating effects of D-Penicillamine (D-PA) play also important role: (i) in attenuating the oxidative stress, (ii) in the transient inhibition of heme oxygenase enzym resulting in a decrease of bilirubin production, and (iii) the age-relating effects of D-PA. Transition biometals now are in the focus of the etiopathogenesis of neurodegenerative and neurodevelopmental diseases (NDs) including the bilirubin-induced neurologic dysfunction (BIND). The “relatively” early diagnosis of jaundice takes suitable neonates for a short time (300 mg/kgbw per os, divided into three parts daily, for 2-5 days) D-PA treatment. It may be affordable especially in poorly resourced countries.